体外膜肺氧合联合肾脏替代治疗在战创伤后脓毒症救治中的应用

Application of extracorporeal membrane oxygenation combined with renal replacement therapy in the treatment of war traumatic sepsis

脓毒症是战创伤致死的重要因素, 尤其是难治性脓毒性休克, 其致死率达50%以上, 脓毒症救治是亟待解决的医疗难题。体外膜肺氧合(ECMO)在心肺功能衰竭救治中的作用与地位越来越突出, 在儿童及婴幼儿脓毒症救治中的成效显著, 但在成人脓毒症救治中的争议依然突出, 当前报道的ECMO救治成人脓毒症的结局相差甚远。ECMO治疗过程可能导致机体肾功能损害, 而肾功能损害则可影响ECMO治疗结局。研究表明脓毒性休克非ECMO治疗过程中辅以肾脏替代治疗可以改善预后, 而在ECMO治疗早期联合肾脏替代治疗能否有效改善治疗结局, 仍需多中心、前瞻性研究予以证实。基于此, 本文对ECMO联合肾脏替代治疗在战创伤后脓毒症救治中应用的相关研究进行综述, 旨在为战创伤后脓毒症的救治提供临床参考。

Sepsis is an important factor for trauma related death,especially the refractory septic shock,which has a mortality rate exceeding 50%.The treatment of sepsis is a medical problem that needs to be solved urgently.The role and status of extracorporeal membrane oxygenation(ECMO)in the treatment of cardiopulmonary failure has become more and more prominent,and its role in the treatment of sepsis in children and infants has gained remarkable achievements.However,its role in adult sepsis remains controversial,with current reports showing varied outcomes for ECMO in adult sepsis treatment.ECMO application can potentially cause renal impairment,and renal impairment can affect the outcomes of ECMO treatment in turn.Studies have shown that adjunctive renal replacement therapy during non-ECMO treatment of septic shock can improve the prognosis,and whether the combination with renal replacement therapy in the early stage of ECMO treatment can effectively improve the treatment outcome still needs to be confirmed by multicenter and prospective studies.Based on this,this article reviews the relevant research on the application of ECMO combined with renal replacement therapy in the treatment of sepsis after war trauma,aiming to provide clinical reference for the treatment of sepsis after war trauma.