体外膜肺氧合在急性中毒中的应用进展

Progress in the application of extracorporeal membrane oxygenation in acute poisoning

急性中毒起病急骤,发展迅速,多数毒物缺乏特效解毒剂,危重症患者即使充分应用血液净化、机械通气和各种药物,多难以改变其死亡结局。近年来,体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)因其显著的心肺功能支持作用在急性中毒救治中逐渐受到重视并被探索性应用,静脉-静脉ECMO用于中毒后严重肺损伤、机械通气无效的急性呼吸窘迫综合征及呼吸衰竭,还可用于协助清除肺部残留毒物;静脉-动脉ECMO常用于中毒后循环衰竭、致命性心律失常及心脏呼吸骤停患者;也有静脉-动脉-静脉ECMO的应用报道。ECMO的模式需要根据病情变化及时调整,目前更多的临床适应证正在探索中。该文结合近年来ECMO在急性中毒中的应用范围和效果进行分析评价,以期更好地探索和合理应用此技术。

Acute poisoning is characterized by a sudden and rapid onset,most poisons lack specific antidotes.Even with the full use of blood purification,mechanical ventilation,and various drugs,it is often difficult to change the fatal outcome of critically ill patients.In recent years,extracorporeal membrane oxygenation(ECMO)has gradually gained attention and exploratory application in the treatment of acute poisoning due to its significant cardiopulmonary function support,veno-venous ECMO is used for severe lung injury after poisoning,acute respiratory distress syndrome and respiratory failure due to ineffective mechanical ventilation,and it can also be used to assist the removal of residual poisons in the lungs.Veno-arterial ECMO is commonly employed in patients with circulatory failure following poisoning,fatal cardiac arrhythmias,and arrest of cardiac and respiratory.The application of veno-arterio-venous ECMO has also been reported.The mode of ECMO necessitates timely adjustments according to the evolving illness,while ongoing exploration of additional clinical indications is underway.This review analyzes and evaluates the application scope and effectiveness of ECMO in acute poisoning in recent years,with a view to better exploring and rationalizing the use of this technology.