体外膜肺氧合相关性脑损伤的研究进展

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)的目的是绕过肺部或心肺系统为严重呼吸衰竭和(或)心力衰竭患者的组织提供足够氧合血.ECMO循环回路本质上由4部分组成:①从静脉系统引血;②提供回路中血流量;③给静脉血液充氧;④将加热后的氧合血液输回静脉或动脉系统.在静脉静脉(VV-)ECMO中,流出管道直接插入静脉系统(通常为股静脉、颈内静脉或锁骨下静脉),而在静脉动脉(VA-)ECMO中,流出插管插入动脉系统(通常为股动脉、锁骨下动脉、腋动脉、颈动脉).ECMO现已成功应用于循环障碍及各种严重呼吸衰竭的支持治疗,但ECMO并发症发生率较高,其中脑组织耗氧量高、氧储备能力低及对缺氧耐受性差是ECMO治疗中最易受损的器官.本综述目的是回顾与ECMO治疗相关的神经系统并发症,总结各种有助于脑血流、脑损伤的监测方法,并探讨脑自动调节功能受损的可能机制.

Research progress of extracorporeal membrane oxygenation-related brain injury

Extracorporeal membrane oxygenation(ECMO)is designed to bypass the lung or cardiopulmonary system to provide adequate oxygenated blood to the tissues of patients with severe respiratory failure and(o r)heart failure.Essentially,the ECMO circulatory circuit consists of four parts:①an inflow pipeline to draw blood from the venous sy ste m;②a blood pump to provide blood flow in the c ir c u it;③an oxygenator to oxygenate venous b lo o d;④a heated oxygenated blood is transported back to the outflow pipeline of the venous or arterial system.In venous vein(VV-)ECMO,the outflow pipe is inserted directly into the venous system(usually femoral vein,internal jugular vein or subclavian v e in),while in venous artery(VA-)ECMO,the outflow tube is inserted into the arterial system(usually femoral artery,subclavian artery,axillary artery and carotid artery can also be used).ECMO has been successfully applied to support the treatment of circulatory disorders and various severe respiratory failure.However,the complications of ECMO are also high,because of high oxygen consumption in brain tissue,low oxygen reserve capacity and poor tolerance to hypoxia,brain is the most vulnerable organ in the treatment of ECMO.The purpose of this review is to review the neurological complications associated with ECMO treatment,summarize various monitoring methods that contribute to cerebral blood flow and brain injury,and explore the possible mechanism of impaired brain autoregulation.