摘要
体外膜肺氧合已成为危重症心肺功能衰竭患者的重要生命支持手段,但其应用常伴随炎症反应、血流动力学紊乱以及急性肾损伤,导致患者血管麻痹、多器官衰竭、病情恶化甚至死亡。血液净化(包括连续性肾脏替代治疗、血浆置换、血液吸附等)是处理急性肾损伤、严重内环境紊乱及炎症风暴的重要手段。二者联合应用在危重症领域日益普遍,尤其在心肾综合征、脓毒症休克、严重中毒等复杂病例中显示出协同救治的潜力。在此背景下,本文拟系统综述体外膜肺氧合联合血液净化的技术整合模式、当前临床适应证及其已证实的疗效,并进一步分析其中的关键技术与管理难点,同时探讨未来优化与发展方向,以期为危重症患者的复杂脏器支持提供循证依据。
Extracorporeal membrane oxygenation has become an essential life-support modality for patients with severe cardiopulmonary failure.However,its application is frequently complicated by systemic inflammatory response syndrome(SIRS),hemodynamic instability,and acute kidney injury,which may lead to vasoplegia,multiple organ failure,clinical deterioration,and even death.Blood purification therapies—including continuous renal replacement therapy,therapeutic plasma exchange,and hemoadsorption—represent pivotal interventions for the management of acute kidney injury,profound metabolic derangements,and cytokine storm.The combined use of extracorporeal membrane oxygenation and blood purification is increasingly prevalent in critical care practice,particularly in complex conditions such as cardiorenal syndrome,septic shock,and severe intoxications,where synergistic therapeutic effects have been demonstrated.Against this background,the present review aims to provide a comprehensive summary of the technical integration models,current clinical indications,and proven efficacy of extracorporeal membrane oxygenation combined with blood purification,while further analyzing key technical challenges and management difficulties.Finally,future directions for optimization and development are discussed,with the goal of furnishing an evidence-based basis for complex multiorgan support in critically ill patients.
作者
赵鹏远
万依辰
孙青松
陈亮
李辉
陈荣杰
石艾琳
赵红梅
ZHAO Pengyuan;WAN Yichen;SUN Qingsong;CHEN Liang;LI Hui;CHEN Rongjie;SHI Ailin;ZHAO Hongmei(Huai'an Clinical College of Xuzhou Medical University,Huai'an,Jiangsu,223300,China;Department of Emergency,the Affiliated Huai'an No.1 People's Hospital of Nanjing Medical University)
出处
《临床急诊杂志》
2025年第11期661-667,共7页
Journal of Clinical Emergency
基金
南京医科大学苏北临床医学研究院科研创新团队项目(No:YLCT202004、YCT202302)。
关键词
体外膜肺氧合
血液净化
连续肾脏替代治疗
血液吸附
oXiris
CytoSorb
血浆置换
血液灌流
extracorporeal membrane oxygenation
blood purification
continuous renal replacement therapy
hemoadsorption
oXiris
CytoSorb
therapeutic plasma exchange
hemoperfusion
