静脉-动脉体外膜氧合支持患者急性肾损伤的研究进展

Research Progress of Acute Kidney Injury in Patients Supported with Venous- arterial Extracorporeal Membrane Oxygenation

静脉-动脉体外膜氧合(V-A ECMO)常用于严重心肺功能衰竭患者,为其提供临时的生命支持,改善了患者的预后,但也常伴一些并发症的发生,其中急性肾损伤较为常见。患者的基础生理状态、V-A ECMO期间的管理以及与低灌注、溶血相关的生化指标改变均与急性肾损伤的发生相关。缺血性损伤、炎症反应、溶血等病理机制相互作用共同导致肾功能的损害,严重的急性肾损伤与患者的不良预后相关,肾脏替代治疗是针对中重度急性肾损伤有效的治疗方法。本文归纳了接受V-A ECMO治疗患者急性肾损伤发生的危险因素、病理生理机制、治疗及预后等方面的特点,以期为临床早期识别及干预提供理论借鉴。

Venous-arterial extracorporeal membrane oxygenation(V-A ECMO) has been widely used in patients with severe cardiopulmonary failure,which can provide temporary life support and reduce patient mortality.However,during V-A ECMO,there are some complications,among which acute kidney injury(AKI) is more common.The patient's basic physiological state,management during V-A ECMO,and changes in biochemical indicators due to hemolysis and hypoperfusion are all associated with the development of acute kidney injury.Ischemic injury,inflammatory reaction,and hemolysis play indispensable roles in the damage of kidney function.Severe AKI is associated with a poor prognosis in patients,and renal replacement therapy is an effective treatment strategy.This article reviews the research progress on the risk factors,pathophysiological mechanism,treatment and prognosis of AKI in patients treated with V-A ECMO,in order to provide theoretical reference for early clinical recognition and intervention.