体外膜肺氧合相关中枢神经系统并发症及防治策略

体外膜肺氧合(extra corporeal membrane oxygenation, ECMO)是危重患者生命支持的重要救治技术,同时也伴随有许多并发症,其中ECMO相关中枢神经系统并发症是导致患者严重不良转归的重要危险因素之一。目前ECMO相关中枢神经系统并发症的真实患病率尚不清楚,据报道其发生率约13%～27%,主要表现为以下五种类型:缺血性卒中、脑出血、癫痫、全脑缺血-缺血缺氧性脑病、脑死亡。ECMO合并中枢神经系统并发症包含多种危险因素,治疗主要依靠内科手段。近些年的研究热点集中在脑电监测(electroencephalography, EEG)等无创监测方面。合并中枢神经系统并发症患者的病死率较未发生者明显升高。通过神经功能监测,可早期发现神经功能损伤进而早期干预并可能改善患者预后。

Recognition and management of neurological complications during extra corporeal membrane oxygenation

Extra corporeal membrane oxygenation(ECMO) is an extracorporeal life support for life-threatening cardiopulmonary failure. Although many patients survive due to its introduction, significant neurological complications like seizures, ischemic strokes, intracranial hemorrhage, ischemic hypoxic encephalopathy, and brain death occur during ECMO and lead to serious adverse outcomes, with high frequency and associated mortality of neurological complications. Although the incidence is reported ranging from 13% to 27%, the prevalence of ECMO-related neurological complications is still unclear. Neurological complications in patients during ECMO associated with lots of risk factors, while the treatments mainly depend on internal medicine. In recent years, non-invasive monitoring is brought into focus, such as electroencephalography (EEG) monitoring and so on.The mortality of patients with ECMO-related neurological complications is much higher than those patients without.The systematic neurological monitoring and early intervention may improve the outcomes.