机械通气策略在体外膜肺氧合过程中的应用

体外膜肺氧合是一种为常规治疗(机械通气)难以治愈的呼吸衰竭患者提供了临时体外呼吸循环支持的技术,在静脉-静脉体外膜肺氧合的过程中,血液从患者的静脉系统进入人工膜肺,进行氧合与二氧化碳的去除,随之再从静脉系统回输至患者体内。为了避免正常肺功能的丧失,机械通气在体外膜肺氧合的过程中仍然有必要,但如何设置体外膜肺氧合过程中的机械通气参数,至今没有明确的指南。因此,本文将简述体外膜肺氧合期间气体交换的病理生理学机制,并就现有证据和文献总结体外膜肺氧合过程中的机械通气策略。

Mechanical ventilation during extracorporeal membrane oxygenation

Extracorporeal membrane oxygenation is a technique for providing temporary extracorporeal respiratory circulation support in patients with respiratory failure who are difficult to treat with conventional therapy(mechanical ventilation).During extracorporeal membrane oxygenation,blood exits from the patient′s venous system,and then enters the artificial membrane lung for oxygenation and carbon dioxide removal,and finally returned to the patient.In order to avoid the loss of normal lung function,mechanical ventilation is still necessary in the process of extracorporeal membrane oxygenation,but there is no clear guidance on how to set mechanical ventilation parameters during extracorporeal membrane oxygenation.Therefore,this article will briefly describe the pathophysiological mechanisms of gas exchange during extracorporeal membrane oxygenation,and summarize the mechanical ventilation strategies in the extracorporeal membrane oxygenation process with available evidence and literature.