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中华产科急救电子杂志

中华产科急救电子杂志 ›› 2022, Vol. 11 ›› Issue (02) : 81 -87. doi: 10.3877/cma.j.issn.2095-3259.2022.02.004

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体外膜肺氧合技术在重症孕产妇救治中的应用
王晓娜1, 白桂芹1,†()   
  1. 1. 710061　西安交通大学第一附属医院妇产科
  • 收稿日期:2022-01-12 出版日期:2022-05-18
  • 通信作者: 白桂芹

The application of ECMO in the treatment of severe pregnant women

Xiaona Wang1, Guiqin Bai1()   

  • Received:2022-01-12 Published:2022-05-18
  • Corresponding author: Guiqin Bai
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王晓娜, 白桂芹. 体外膜肺氧合技术在重症孕产妇救治中的应用[J]. 中华产科急救电子杂志, 2022, 11(02): 81-87.

Xiaona Wang, Guiqin Bai. The application of ECMO in the treatment of severe pregnant women[J]. Chinese Journal of Obstetric Emergency(Electronic Edition), 2022, 11(02): 81-87.

体外膜肺氧合技术(extracorporeal membrane oxygenation，ECMO)在危重症患者中的应用越来越广泛，为患者心肺功能恢复赢得了时间。随着科学技术的发展，ECMO技术也发生了巨大变化，新的小口径导管简化了血管通路，长效抗凝涂层技术的应用提高了ECMO系统的组织相容性、降低了对血液的破坏、减少了炎症反应的发生及血栓形成，使ECMO技术变得更加简单和安全。一些严重的妊娠和分娩并发症可能会导致孕产妇的心脏或肺功能衰竭，故其在重症孕产妇的使用率也有所上升。本文就在救治重症孕产妇时使用ECMO的适应证、并发症及注意事项等方面进行阐述。

关键词: 体外膜氧合作用, 危重病人医疗, 妊娠并发症, 心力衰竭, 呼吸功能不全

Extracorporeal membrane oxygenation (ECMO) is more widely used in critically ill patients, which has gained time for the recovery of cardiopulmonary function. The ECMO technology has undergone dramatic changes. New small-diameter catheters have simplified vascular access, and the application of long-lasting anticoagulant coatings has improved the ECMO system′s histocompatibility, reduced blood damage, and reduced inflammation and thrombosis. ECMO has become simpler and safer. Because some serious pregnancy and delivery complications may lead to heart or lung failure, the use of ECMO during the perinatal period has also increased. In this paper, the indications, complications and matters needing attention of ECMO during perinatal severe illnesses were discussed.

Key words: Extracorporeal membrane oxygenation (ECMO), Critical care, Pregnancy complications, Heart failure, Respiratory insufficiency
表1 围产期VV-ECMO及VA-ECMO支持的潜在适应证[32]
VV-ECMO
  1.严重(但可逆的)呼吸衰竭
  2.高碳酸血症伴严重呼吸性酸中毒，尽管使用最佳的常规机械通气，呼吸频率增加到35次/min
  3.早期使用肌松剂治疗ARDS、俯卧位通气和适当的PEEP处理后，PaO2/FiO2<100，伴有FiO2≥0.9及PEEP≥10 cmH2O
VA-ECMO
  1.围产期心肌病、心肌梗死、心肌炎引起的顽固性左心室衰竭
  2.疑似羊水栓塞患者的顽固性右心或左心衰竭
  3.大面积肺动脉栓塞伴顽固性右心室衰竭
  4.需要长时间心肺复苏(至少10 min)，并有可能出现可逆的情况
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