循环及呼吸机械支持设备在心脏急危重症救治中的发展现状

Development status of circulatory and respiratory mechanical support equipment in the treatment of cardiac emergencies and critical illnesses

循环及呼吸机械辅助装置是能够部分或全部替代心脏或肺脏功能的机械设备统称,近年来在心脏急危重症领域中的应用日益频繁。主动脉内球囊反搏(IABP)是世界范围内使用最广泛的机械循环辅助设备,具有管理难度较低等优势,但近年来因阴性循证结论导致其在各国指南中推荐级别下降且在临床应用减少;经皮左室辅助装置可提供更强的循环支持能力,但受限于临床研究数量不足,而缺乏优于IABP技术的循证依据;体外膜肺氧合(ECMO)技术可同时对患者提供循环和呼吸支持,近年来有关其单独或联合其他机械循环支持设备使用有利于心脏危重症患者预后的循证依据不断涌现,在临床应用越来越广泛。无创呼吸机被广泛用于包括急性心力衰竭在内的各类心脏危重场景,不仅可减轻心脏前负荷,也可预防患者呼吸衰竭进一步进展,以致使用有创呼吸机辅助通气。本文将对上述机械设备应用的原理、发展脉络以及应用现状等进行总结阐述。

Circulatory and respiratory mechanical supportive equipment refers to mechanical devices that can partially or completely replace the function of organs such as heart or lung.With the advent of aging,the application of these devices in the field of cardiac emergencies is becoming increasingly frequent.Intra-aortic balloon pump is the most widely used mechanical circulatory assistance device worldwide,with advantages such as relatively lower difficulty in process management.However,in recent years,a series of negative evidence-based conclusions have led to a decrease in its recommended level in national guidelines and its clinical application.Percutaneous left ventricular assist devices can provide stronger circulatory support,but due to the limited number of clinical studies,they have not yet demonstrated evidence-based evidence superior to intra-aortic balloon pump.Extracorporeal membrane oxygenation technology can provide support for both circulation and respiration in patients.In recent years,evidence-based evidence has emerged that its use alone or in combination with other mechanical circulatory support devices is beneficial for the prognosis of critically ill cardiac patients,making the clinical application of this type of technology increasingly widespread.Non-invasive ventilators are widely used in various critical cardiac scenarios,including acute heart failure.They can not only reduce cardiac preload,but also prevent patients from further developing respiratory failure,leading to the use of invasive ventilators for assisted ventilation.Overall,the application of respiratory and circulatory mechanical assistive devices in the field of cardiac emergencies has become increasingly widespread in recent years,and it is worth exploring in depth.