{"id":53840,"date":"2025-06-30T05:10:39","date_gmt":"2025-06-30T05:10:39","guid":{"rendered":"http:\/\/zydq.1006ss.com\/?p=53840"},"modified":"2025-06-30T05:10:39","modified_gmt":"2025-06-30T05:10:39","slug":"%e4%bd%93%e5%a4%96%e5%bf%83%e8%82%ba%e5%a4%8d%e8%8b%8f%ef%bc%88ecpr%ef%bc%89","status":"publish","type":"post","link":"http:\/\/zydq.1006ss.com\/?p=53840","title":{"rendered":"\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\uff08ECPR\uff09"},"content":{"rendered":"<h2>\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u540e\u6210\u4eba\u60a3\u8005\u7684\u5fc3\u810f\u9aa4\u505c\u540e\u6cbb\u7597<\/h2>\n<p>Bingo&nbsp;\u658c\u54e5\u8bdd\u91cd\u75c7&nbsp;<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\uff08ECPR\uff09\u91c7\u7528\u9759\u8109\u52a8\u8109\u4f53\u5916\u819c\u80ba\u6c27\u5408\uff08ECMO\uff09\u6280\u672f\uff0c\u7528\u4e8e\u6cbb\u7597\u96be\u6cbb\u6027\u5fc3\u810f\u9aa4\u505c\uff08CA\uff09\u60a3\u8005\u3002\u6b27\u6d32\u590d\u82cf\u59d4\u5458\u4f1a\u548c\u7f8e\u56fd\u5fc3\u810f\u534f\u4f1a\u5efa\u8bae\u6709\u9009\u62e9\u6027\u5730\u5c06 ECPR \u7528\u4e8e\u5177\u6709\u6f5c\u5728\u53ef\u9006\u6027\u75c5\u56e0\u7684\u5fc3\u810f\u9aa4\u505c\u60a3\u8005\uff0c\u5e76\u5728\u4e13\u4e1a\u7684 ECMO \u4e2d\u5fc3\u8fc5\u901f\u5f00\u5c55\u3002\u7814\u7a76\u663e\u793a\u7684\u7ed3\u679c\u4e0d\u5c3d\u76f8\u540c\uff0c\u65e2\u6709\u663e\u8457\u7684\u751f\u5b58\u83b7\u76ca\uff0c\u4e5f\u6709\u6a21\u68f1\u4e24\u53ef\u7684\u7ed3\u679c\u3002\u7136\u800c\uff0c\u8fd9\u4e9b ECPR \u8bd5\u9a8c\u53d7\u9650\u4e8e\u6837\u672c\u91cf\u4e0d\u8db3\u548c\u7f3a\u4e4f\u666e\u904d\u6027\uff082\/3 \u7684\u7814\u7a76\u4e3a\u5355\u4e2d\u5fc3\u7814\u7a76\u8bbe\u8ba1\uff09\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u5728\u8fd9\u4e9b\u8bd5\u9a8c\u4e2d\uff0c\u7531\u4e8e\u7f3a\u4e4f\u6807\u51c6\u5316\u7ba1\u7406\u548c\u4e34\u5e8a\u7814\u7a76\u4e2d\u7684\u5b9a\u4e49\u4e0d\u7edf\u4e00\uff0c\u5bf9\u91cd\u75c7\u76d1\u62a4\u5ba4\u91cd\u75c7\u76d1\u62a4\u540e\u7684\u7ba1\u7406\u5e76\u6ca1\u6709\u5f88\u597d\u7684\u63cf\u8ff0\u3002\u5e38\u89c4 CA \u60a3\u8005\u7684\u89c4\u8303\u5316\u3001\u591a\u5b66\u79d1\u7ba1\u7406\u5bf9\u751f\u5b58\u6709\u663e\u8457\u5f71\u54cd\uff0c\u63a8\u8350\u7b49\u7ea7\u4e3a I\u3002\u56e0\u6b64\uff0cECPR \u540e\u7684 CA \u540e\u6cbb\u7597\u5bf9\u8fd9\u4e9b\u60a3\u8005\u7684\u77ed\u671f\u548c\u957f\u671f\u9884\u540e\u6709\u91cd\u5927\u5f71\u54cd\u3002\u5728\u6b64\uff0c\u6211\u4eec\u4e3a ECPR \u60a3\u8005\u7684 CA ICU \u540e\u6cbb\u7597\u63d0\u4f9b\u4e86\u4e00\u4efd\u7b80\u660e\u627c\u8981\u7684\u7efc\u8ff0\u548c\u5b9e\u7528\u6307\u5357\u3002<\/p>\n<p>ECPR \u7684 CA&nbsp;\u540e\u6cbb\u7597<\/p>\n<p>\u5faa\u73af<\/p>\n<p>&nbsp;&nbsp; &nbsp; &nbsp; ECPR \u6700\u5e38\u89c1\u7684\u63d2\u7ba1\u7b56\u7565\u662f\u80a1\u9759\u8109\u5f15\u6d41\u548c\u80a1\u52a8\u8109\u6d41\u51fa\u7684\u5916\u5468\u63d2\u7ba1\uff0c\u8fd9\u5c06\u662f\u6211\u4eec\u56de\u987e\u548c\u5efa\u8bae\u7684\u91cd\u70b9\u3002\u63d2\u7ba1\u540e\uff0c\u5e94\u7acb\u5373\u589e\u52a0 ECMO \u6d41\u91cf\uff0c\u76ee\u6807\u4e3a 3-4 L\/min\u3002\u52a8\u9759\u8109\u6c27\u5dee\u662f\u786e\u5b9a ECMO \u6d41\u91cf\u76ee\u6807\u7684\u53ef\u9760\u53c2\u6570\uff0c\u56e0\u4e3a\u5b83\u4e0d\u53d7\u8840\u7ea2\u86cb\u767d\u6c34\u5e73\u7684\u5f71\u54cd\uff0c\u5e94\u4fdd\u6301\u5728 3 \u81f3 5 cc \u6c27\/100 mL \u8840\u6db2\u4e4b\u95f4\u3002\u6df7\u5408\u9759\u8109\u9971\u548c\u5ea6\u76ee\u6807\u9ad8\u4e8e 66% \u548c\u4f9b\u6c27\u91cf\u4e0e\u8017\u6c27\u91cf\u4e4b\u6bd4\u76ee\u6807\u9ad8\u4e8e 3 \u662f\u4f9d\u8d56\u4e8e\u8840\u7ea2\u86cb\u767d\u7684\u53c2\u6570\uff0c\u56e0\u6b64\u53ef\u80fd\u4e0d\u90a3\u4e48\u53ef\u9760\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u52a8\u8109\u8840\u6c14\u5e94\u6765\u81ea\u53f3\u4fa7\u6861\u52a8\u8109\u7ba1\u8def\uff0c\u56e0\u4e3a\u4ece\u8fd9\u4e2a\u90e8\u4f4d\u8fdb\u884c\u6d4b\u91cf\u867d\u7136\u5e76\u4e0d\u5b8c\u7f8e\uff0c\u56e0\u4e3a\u5b83\u5ffd\u7565\u4e86\u51a0\u72b6\u52a8\u8109\u7684\u8840\u6db2\u6c27\u5408\uff0c\u4f46\u5374\u6700\u80fd\u4f53\u73b0\u5347\u4e3b\u52a8\u8109\/\u5fc3\u5185\u819c\u7684\u60c5\u51b5\uff0c\u56e0\u6b64\u4e5f\u6700\u80fd\u4f53\u73b0\u8111\u704c\u6ce8\u60c5\u51b5\u3002\u5728\u5916\u5468\u63d2\u7ba1\u7684\u60a3\u8005\u4e2d\uff0c\u7531\u4e8e\u80ba\u6c14\u4f53\u4ea4\u6362\u4e0d\u826f\uff0c\u5de6\u5fc3\u5ba4\uff08LV\uff09\u5c04\u51fa\u7684\u542b\u6c27\u91cf\u4e0d\u8db3\u7684\u8840\u6db2\u53ef\u5f62\u6210\u53cc\u5faa\u73af\uff0c\u5373\u524d\u5411\u4f4e\u6c27\u8840\u6db2\u548c\u540e\u5411\u9ad8\u6c27 ECMO \u8840\u6d41\u5bfc\u81f4\u4e0a\u4e0b\u8eaf\u5e72\u6c27\u5408\u4e0d\u540c\uff0c\u8fd9\u79cd\u73b0\u8c61\u88ab\u79f0\u4e3a\u4e11\u89d2\uff08Harlequins\uff09\u6216\u5357\u5317\u7efc\u5408\u5f81\uff0c\u7ea6\u5360\u5916\u5468\u63d2\u7ba1\u60a3\u8005\u7684 10%\u3002\u8ba4\u8bc6\u5230\u6765\u81ea\u53f3\u6861\u52a8\u8109\u7ba1\u8def\u7684\u72ed\u7a84\u8109\u538b\u8868\u660e\u6df7\u5408\u70b9\u4f4d\u4e8e\u8179\u5185\u52a8\u8109\u8fd1\u7aef\uff0c\u800c\u5de6\u5fc3\u5ba4\u5c04\u8840\u5bfc\u81f4\u7684\u5bbd\u8109\u538b\u8868\u660e\u6df7\u5408\u70b9\u4f4d\u4e8e\u66f4\u8fdc\u7aef . Harlequins \u7efc\u5408\u5f81\u7684\u5904\u7406\u65b9\u6cd5\u5305\u62ec\u589e\u52a0 ECMO \u6d41\u91cf\u4ee5\u51cf\u8f7b\u4e0d\u540c\u7a0b\u5ea6\u7684\u4f4e\u6c27\u8840\u75c7\uff0c\u8c03\u6574\u547c\u5438\u673a\u8bbe\u7f6e\u4ee5\u63d0\u9ad8\u539f\u751f\u5faa\u73af\u8840\u6db2\u7684\u542b\u6c27\u91cf\uff0c\u6216\u5728\u9888\u9759\u8109\u63d2\u5165\u542b\u6c27\u56de\u6d41\u63d2\u7ba1\u4ee5\u5411\u53f3\u5fc3\u63d0\u4f9b\u542b\u6c27\u8840\u6db2\uff0c\u8fd9\u79cd\u6df7\u5408\u914d\u7f6e\u79f0\u4e3a\u9759\u8109-\u52a8\u9759\u8109 ECMO\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u6700\u4f73\u5e73\u5747\u52a8\u8109\u538b (MAP) \u56e0\u60a3\u8005\u800c\u5f02\uff0c\u4f46\u7ef4\u6301\u4e00\u4e2a\u65e2\u80fd\u63d0\u4f9b\u8db3\u591f\u7684\u5927\u8111\u548c\u672b\u68a2\u5668\u5b98\u704c\u6ce8\uff0c\u53c8\u80fd\u5c06\u5de6\u5fc3\u5ba4\u540e\u8d1f\u8377\u964d\u81f3\u6700\u4f4e\u7684 MAP \u5bf9\u4e8e\u786e\u4fdd\u5faa\u73af\u652f\u6301\u548c\u5fc3\u810f\u6062\u590d\u81f3\u5173\u91cd\u8981\u3002\u63d2\u7ba1\u540e\uff0c\u5e94\u505c\u6b62\u673a\u68b0\u80f8\u5916\u6309\u538b\uff0c\u5e76\u5728\u53ef\u8010\u53d7\u7684\u60c5\u51b5\u4e0b\u65ad\u5f00\u8840\u7ba1\u6d3b\u6027\u808c\u529b\u652f\u6301\u3002\u4f46\u662f\uff0c\u5fc5\u987b\u59cb\u7ec8\u7262\u8bb0\u5145\u5206\u7684\u5faa\u73af\u652f\u6301\u3001\u5de6\u5fc3\u5ba4\u5c04\u8840\u3001\u5de6\u5fc3\u5ba4\u58c1\u5f20\u529b\/\u5f20\u529b\u6700\u5c0f\u5316\u4ee5\u53ca\u4e0a\u8eaf\u5e72\u4e0d\u540c\u6c27\u5408\u7b49\u95ee\u9898\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5916\u5468\u9759\u8109\u52a8\u8109 ECMO \u4f1a\u589e\u52a0\u5de6\u5fc3\u5ba4\u540e\u8d1f\u8377\uff0c\u4ece\u800c\u5bf9\u5fc3\u810f\u6062\u590d\u4ea7\u751f\u8d1f\u9762\u5f71\u54cd\u3002\u4f7f\u7528\u6b63\u6027\u808c\u529b\u836f\u652f\u6301\u5c04\u8840\u53ef\u51cf\u8f7b\u5de6\u5fc3\u5ba4\u6269\u5f20\u3002\u867d\u7136\u5728\u8840\u7ba1\u6269\u5f20\u548c\u4f4e\u8840\u538b\u7684\u60c5\u51b5\u4e0b\u53ef\u4ee5\u4f7f\u7528\u80be\u4e0a\u817a\u7d20\uff0c\u4f46\u7531\u4e8e\u5355\u72ec\u4f7f\u7528\u80be\u4e0a\u817a\u7d20\u4e0e\u8f83\u9ad8\u7684\u6b7b\u4ea1\u7387\u76f8\u5173\uff0c\u56e0\u6b64\u9996\u9009\u53bb\u7532\u80be\u4e0a\u817a\u7d20\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u8fd8\u53ef\u901a\u8fc7\u989d\u5916\u7684\u673a\u68b0\u5faa\u73af\u652f\u6301\u5b9e\u73b0\u5de6\u5fc3\u5ba4\u5378\u8d1f\u8377\uff0c\u4ece\u800c\u9632\u6b62\u5fc3\u5ba4\u6269\u5f20\u3001\u5fc3\u5ba4\u6de4\u8840\u3001\u80ba\u5145\u8840\u548c\u5fc3\u808c\u7f3a\u8840\uff0c\u5bf9 ECMO \u65ad\u6d41\u548c\u9662\u5185\u5b58\u6d3b\u4ea7\u751f\u6709\u5229\u5f71\u54cd\u3002\u8fd9\u4e9b\u65b9\u6cd5\u5305\u62ec\u7ecf\u76ae\u7597\u6cd5\uff0c\u5982\u4e3b\u52a8\u8109\u5185\u7403\u56ca\u53cd\u640f\u6cf5\uff08IABP\uff09\u3001Impella \u548c\u7ecf\u9888\u5185\u9759\u8109\u7684\u80ba\u52a8\u8109\u901a\u6c14\uff0c\u4ee5\u53ca\u7ecf\u53f3\u9888\u5185\u63d2\u7ba1\u3001\u5fc3\u623f\u9694\u819c\u9020\u53e3\u672f\u6216\u7ecf\u80f8\u524d\u5207\u53e3\u76f4\u63a5\u5de6\u5fc3\u5ba4\u5fc3\u5c16\u63d2\u7ba1\u7684\u80ba\u52a8\u8109\u51cf\u538b\u7b49\u66f4\u5177\u521b\u4f24\u6027\u7684\u65b9\u6cd5\u3002\u6700\u5408\u9002\u7684\u51cf\u538b\u7b56\u7565\u5e94\u8be5\u662f\u521b\u4f24\u6700\u5c0f\u4f46\u6700\u6709\u6548\u7684\u3002\u8868 1 \u5217\u51fa\u4e86\u6839\u636e\u8fd1\u671f\u4e13\u5bb6\u5171\u8bc6\u5236\u5b9a\u7684 LV \u8d1f\u8377\u7b56\u7565\u53ca\u5176\u7597\u6548\u3002\u9274\u4e8eImpella\u548cIABP\u53ef\u80fd\u4f1a\u52a0\u91cd\u4e0d\u540c\u7a0b\u5ea6\u7684\u4f4e\u6c27\u8840\u75c7\u548c\u4e11\u89d2\u7efc\u5408\u5f81\uff0c\u56e0\u6b64\u5728\u547c\u5438\u8870\u7aed\u7684\u60c5\u51b5\u4e0b\u5e94\u8c28\u614e\u4f7f\u7528\u3002<\/p>\n<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u9274\u4e8e\u65e9\u671f\u51a0\u8109\u518d\u704c\u6ce8\u80fd\u591f\u63d0\u9ad8\u5fc3\u80ba\u590d\u82cf(ECPR)\u60a3\u8005\u7f3a\u8840\u6027\u51a0\u8109\u52a8\u8109\u8840\u4f9b\u7684\u7ed3\u679c\uff0c\u63d2\u7ba1\u540e\u5feb\u901f\u8fdb\u884c\u7ecf\u76ae\u51a0\u72b6\u52a8\u8109\u4ecb\u5165\u53ef\u80fd\u62ef\u6551\u751f\u547d\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5728\u9759\u8109\u52a8\u8109 ECMO \u4e2d\uff0c\u4e0e\u704c\u6ce8\u4e13\u5bb6\u7684\u6301\u7eed\u5408\u4f5c\u81f3\u5173\u91cd\u8981\u3002\u4ed6\u4eec\u5728\u89e3\u51b3\u673a\u68b0\u95ee\u9898\u3001\u7ba1\u7406\u6297\u51dd\u3001\u4f18\u5316\u6c14\u4f53\u4ea4\u6362\u76ee\u6807\u3001\u76d1\u6d4b\u5fc3\u8f93\u51fa\u91cf\u548c\u8c03\u8282\u56de\u8def\u6e29\u5ea6\u7b49\u65b9\u9762\u7684\u4e13\u4e1a\u77e5\u8bc6\u5927\u5927\u52a0\u5f3a\u4e86\u5bf9\u60a3\u8005\u7684\u6cbb\u7597\u3002<\/p>\n<p>\u6c14\u9053\u548c\u547c\u5438<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u6240\u6709 ECPR \u60a3\u8005\u5728\u5faa\u73af\u6062\u590d\u540e\u90fd\u8981\u8fdb\u884c\u6c14\u7ba1\u63d2\u7ba1\u3002\u867d\u7136 ECMO \u53ef\u4ee5\u63d0\u4f9b\u5145\u8db3\u7684\u6c27\u5408\u548c\u901a\u6c14\uff0c\u4f46\u901a\u5e38\u9700\u8981\u7ef4\u6301\u673a\u68b0\u901a\u6c14\uff0c\u4ee5\u786e\u4fdd ECMO \u671f\u95f4\u80ba\u90e8\u6269\u5f20\u3002\u66f4\u91cd\u8981\u7684\u662f\uff0c\u901a\u8fc7\u673a\u68b0\u901a\u6c14\u63d0\u4f9b\u5145\u8db3\u7684\u6c27\u5408\u6709\u52a9\u4e8e\u9884\u9632\u4e11\u89d2\u7efc\u5408\u5f81\uff0c\u56e0\u4e3a\u5916\u5468\u9759\u8109\u52a8\u8109 ECMO \u53ef\u80fd\u65e0\u6cd5\u4e3a\u5347\u4e3b\u52a8\u8109\u63d0\u4f9b\u5145\u8db3\u7684\u6c27\u5408\u3002\u5e94\u8c03\u8282 Fio2 \u4ee5\u7ef4\u6301\u52a8\u8109\u8840\u6c27\u9971\u548c\u5ea6\u5927\u4e8e 92%\u3002\u5c3d\u7ba1\u5728\u786e\u5b9a ECPR \u60a3\u8005\u7684\u6700\u4f73\u547c\u5438\u673a\u6a21\u5f0f\u65b9\u9762\u7f3a\u4e4f\u786e\u5207\u8bc1\u636e\uff0c\u4f46\u5efa\u8bae\u91c7\u7528\u80ba\u4fdd\u62a4\u7b56\u7565\u3002\u53ef\u4ee5\u91c7\u7528\u4f4e\u901a\u6c14\u538b\u529b\u548c\u547c\u5438\u9891\u7387\uff0c\u56e0\u4e3a\u8fd9\u4e9b\u56e0\u7d20\u4e0e\u63d0\u9ad8 ECPR \u60a3\u8005\u7684\u5b58\u6d3b\u7387\u6709\u5173\u3002\u5173\u4e8e ECMO \u671f\u95f4\u7406\u60f3\u7684\u547c\u6c14\u672b\u6b63\u538b\uff08PEEP\uff09\u8bbe\u7f6e\u5c1a\u672a\u8fbe\u6210\u5171\u8bc6\uff0c\u4f46\u6839\u636e\u4f53\u5916\u751f\u547d\u652f\u6301\u7ec4\u7ec7\uff08ELSO\uff09\u6307\u5357\u548c\u6211\u4eec\u81ea\u5df1\u7684\u5b9e\u8df5\uff0c\u6211\u4eec\u5efa\u8bae PEEP \u4fdd\u6301\u5728 10 cm H2O \u5de6\u53f3\uff0c\u9664\u975e\u6c27\u5408\u9700\u8981\u989d\u5916\u7684 PEEP\u3002\u8f83\u9ad8\u7684\u57fa\u7ebf PEEP \u6709\u52a9\u4e8e\u547c\u6c14\u540e\u7684\u80ba\u590d\u5f20\uff0c\u5e76\u6700\u5927\u9650\u5ea6\u5730\u51cf\u5c11\u56e0\u80ba\u6ce1\u6253\u5f00\u548c\u5173\u95ed\u800c\u9020\u6210\u7684\u635f\u4f24\uff08\u4e0d\u5f20\u4f24\uff09\u3002\u5bf9\u51cf\u5c11 ECPR \u60a3\u8005\u7684\u5fc3\u6e90\u6027\u80ba\u6c34\u80bf\u8fd8\u6709\u6f5c\u5728\u7684\u597d\u5904\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; ECPR \u540e\uff0c\u60a3\u8005\u5f80\u5f80\u5408\u5e76\u547c\u5438\u548c\u4ee3\u8c22\u6027\u9178\u4e2d\u6bd2\uff08\u4e25\u91cd\u4e73\u9178\u9178\u4e2d\u6bd2\uff09\u3002\u7531\u4e8e\u4f4e pH \u503c\u4e0e\u8f83\u9ad8\u7684\u9662\u5185\u6b7b\u4ea1\u7387\u76f8\u5173\uff0c\u8c03\u8282 ECMO \u6c27\u5408\u5668\u4e0a\u7684\u626b\u6c14\u6d41\u91cf\u4ee5\u8fbe\u5230\u6b63\u5e38\u6216\u8f7b\u5fae\u78b1\u5316\u7684 pH \u503c\u662f\u4e00\u79cd\u5e38\u89c1\u7684\u4e34\u5e8a\u5b9e\u8df5\uff0c\u4f46\u63d2\u7ba1\u540e\u65e9\u671f\u7ea0\u6b63 pH \u503c\u7684\u901f\u5ea6\u5e76\u4e0d\u786e\u5b9a\u3002<\/p>\n<p>\u6c27\u548c\u4e8c\u6c27\u5316\u78b3<\/p>\n<p>&nbsp;&nbsp;&nbsp; &nbsp;&nbsp;\u591a\u9879\u7814\u7a76\u8868\u660e\uff0c\u65e9\u671f\u9ad8\u6c27\uff08Pao2 &gt; 300 mm Hg\uff09\u4e0e\u6b7b\u4ea1\u7387\u548c\u4e0d\u826f\u795e\u7ecf\u529f\u80fd\u9884\u540e\u6709\u5173\u3002\u867d\u7136\u6700\u4f73\u6c27\u5408\u76ee\u6807\u5c1a\u672a\u786e\u5b9a\uff0c\u4f46\u901a\u8fc7\u8c03\u8282 ECMO \u626b\u6c14 Fio2 \u4ee5\u8fbe\u5230 92-97% \u7684\u52a8\u8109\u8840\u6c27\u9971\u548c\u5ea6\uff0c\u4ece\u800c\u907f\u514d\u65e9\u671f\u9ad8\u6c27\u662f\u5408\u7406\u7684\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u5e94\u91c7\u53d6\u9884\u9632\u63aa\u65bd\uff0c\u9632\u6b62 Paco2 \u5feb\u901f\u4e0b\u964d\u3002\u56f4ECMO\u63d2\u7ba1\u671f\u8f7b\u5ea6\u9ad8\u78b3\u9178\u8840\u75c7\u53ef\u51cf\u8f7b\u7f3a\u8840\u6027\u6025\u6027\u8111\u635f\u4f24\uff08ABI\uff09\u7684\u98ce\u9669\uff0c\u56e0\u4e3a Paco2 \u5347\u9ad8\u53ef\u4fc3\u8fdb\u8111\u8840\u7ba1\u8212\u5f20\uff0c\u589e\u52a0\u8840\u6d41\u91cf\uff0c\u8fd9\u4e9b\u60a3\u8005 ABI \u7684\u8840\u6e05\u751f\u7269\u6807\u5fd7\u7269\u964d\u4f4e\u5c31\u8bc1\u660e\u4e86\u8fd9\u4e00\u70b9\u3002\u7136\u800c\uff0c\u4e2d\u5ea6\u9ad8\u78b3\u9178\u8840\u75c7\u53ef\u80fd\u4f1a\u5bfc\u81f4\u9885\u5185\u538b\u5347\u9ad8\uff08\u8840\u7ba1\u6269\u5f20\uff09\uff0c\u8fd9\u5bf9\u5df2\u7ecf\u53d1\u751f ABI \u7684\u60a3\u8005\u6765\u8bf4\u53ef\u80fd\u662f\u707e\u96be\u6027\u7684\u3002\u4e8b\u5b9e\u4e0a\uff0c\u4e00\u9879\u9488\u5bf9\u666e\u901a\u9759\u8109\u52a8\u8109 ECMO \u60a3\u8005\uff08\u975eECPR\uff09\u7684\u7814\u7a76\u53d1\u73b0\uff0c\u9885\u5468 Paco2 \u7684\u5927\u5e45\u4e0b\u964d\uff08\u2206Paco2\uff09\u4e0e\u9885\u5185\u51fa\u8840\uff08ICH\uff09\u6709\u5173\u3002\u57fa\u4e8e ELSO \u6ce8\u518c\u8868\u7684\u7814\u7a76\u8868\u660e\uff0c\u63d2\u7ba1\u540e 24 \u5c0f\u65f6\u5185 Paco2 \u5927\u5e45\u5ea6\u4e0b\u964d\u4e0e\u9759\u8109\u52a8\u8109 ECMO \u4e2d\u66f4\u591a\u7684 ABI \u548c ECPR \u4e2d\u66f4\u5dee\u7684\u5b58\u6d3b\u7387\u6709\u5173\u3002\u9700\u8981\u9ad8\u8d28\u91cf\u7684\u524d\u77bb\u6027\u591a\u4e2d\u5fc3\u6570\u636e\u6765\u786e\u5b9a\u63d2\u7ba1\u540e\u7684\u9002\u5f53 Co2 \u76ee\u6807\u3002\u5728\u6b64\u4e4b\u524d\uff0c\u6700\u597d\u5c06 Paco2 \u76ee\u6807\u503c\u8bbe\u5b9a\u5728 35 \u81f3 45 mm Hg \u4e4b\u95f4\uff0c\u540c\u65f6\u907f\u514d\u7684\u5feb\u901f\u2206Paco2\uff08&gt; 20 mm Hg\uff09\u3002<\/p>\n<p>\u9547\u75db<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u9547\u75db\u662f\u4e00\u79cd\u5728\u4f7f\u7528\u9547\u9759\u5242\u4e4b\u524d\u4f18\u5148\u8003\u8651\u9547\u75db\u7684\u6cbb\u7597\u65b9\u6cd5\u3002\u5176\u76ee\u6807\u5305\u62ec\u63a7\u5236\u75bc\u75db\u3001\u9884\u9632\u548c\u6cbb\u7597\u8e81\u52a8\u3001\u786e\u4fdd\u547c\u5438\u673a\u540c\u6b65\u3001\u4f18\u5316 ECMO \u6d41\u91cf\u3001\u51cf\u5c11\u4ee3\u8c22\u9700\u6c42\u4ee5\u53ca\u63d0\u9ad8\u957f\u671f\u529f\u80fd\u7ed3\u679c\u3002\u9547\u75db\u5242\u4f7f\u7528\u8fc7\u5ea6\u6216\u4e0d\u8db3\u90fd\u4f1a\u5bf9\u529f\u80fd\u548c\u8ba4\u77e5\u7ed3\u679c\u4ea7\u751f\u8d1f\u9762\u5f71\u54cd\u3002\u5728 ECMO \u542f\u52a8\u65f6\uff0c\u53ef\u80fd\u9700\u8981\u66f4\u6df1\u5c42\u6b21\u7684\u9547\u9759\uff0c\u4ee5\u4f18\u5316\u8840\u6d41\u548c\u5185\u810f\u5668\u5b98\u704c\u6ce8\u3002\u968f\u7740\u60a3\u8005\u75c5\u60c5\u7684\u7a33\u5b9a\uff0c\u5e94\u51cf\u8f7b\u9547\u9759\u7a0b\u5ea6\uff0c\u4ee5\u83b7\u5f97\u795e\u7ecf\u7cfb\u7edf\u8bc4\u4f30\u7ed3\u679c\uff0c\u7136\u540e\u518d\u6839\u636e\u8212\u9002\u5ea6\u8fdb\u884c\u8c03\u6574\u3002\u4e25\u91cd\u5371\u91cd\u75c7\u53ef\u5bfc\u81f4\u836f\u6548\u5b66\u7684\u53d8\u5316\uff0c\u800c ECMO \u56de\u8def\u53c8\u8fdb\u4e00\u6b65\u6539\u53d8\u4e86\u836f\u6548\u5b66\uff0c\u4eb2\u8102\u6027\u548c\u86cb\u767d\u7ed3\u5408\u836f\u7269\u7684\u5206\u5e03\u5bb9\u79ef\u548c\u87af\u5408\u4f5c\u7528\u7684\u53d8\u5316\u663e\u8457\u964d\u4f4e\u4e86\u8fd9\u4e9b\u836f\u7269\u7684\u751f\u7269\u5229\u7528\u5ea6\u3002\u6c22\u5417\u5561\u916e\u662f\u63a8\u8350\u7684\u4e00\u7ebf\u9759\u8109\u9547\u75db\u836f\u7269\uff0c\u800c\u82ac\u592a\u5c3c\u53ef\u80fd\u4e0d\u662f\u6700\u4f73\u836f\u7269\uff0c\u56e0\u4e3a\u5b83\u5728\u56de\u8def\u4e2d\u88ab\u9ad8\u5ea6\u87af\u5408\u3002\u4e00\u7ebf\u80a0\u5185\u7528\u836f\u662f\u7f9f\u8003\u916e\uff0c\u7136\u540e\u662f\u53e3\u670d\u6c22\u5417\u5561\u916e\uff0c\u5e76\u8f85\u4ee5\u52a0\u5df4\u55b7\u4e01\u4ee5\u51cf\u8f7b\u795e\u7ecf\u6027\u75bc\u75db\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u975e\u82ef\u4e8c\u6c2e\u5353\u7c7b\u836f\u7269\u9547\u9759\u5242\u5982\u53f3\u7f8e\u6258\u54aa\u5b9a\u548c\u6c2f\u80fa\u916e\u662f\u9996\u9009\u7684\u8f85\u52a9\u9547\u9759\u5242\u3002\u7531\u4e8e\u4e19\u6cca\u915a\u5728\u56de\u8def\u4e2d\u7684\u87af\u5408\u4f5c\u7528\u8f83\u5f3a\uff0c\u56e0\u6b64\u5e76\u975e\u6700\u4f73\u836f\u7269\uff0c\u4f46\u5728\u9700\u8981\u66f4\u6df1\u5ea6\u7684\u9547\u9759\u65f6\u53ef\u4ee5\u4f7f\u7528\u3002\u5fc5\u8981\u65f6\uff0c\u95f4\u6b47\u6027\u4f7f\u7528\u9759\u8109\u6ce8\u5c04\u52b3\u62c9\u897f\u6cee\uff0c\u540c\u65f6\u6309\u8ba1\u5212\u5242\u91cf\u4f7f\u7528\u80a0\u5185\u82ef\u4e8c\u6c2e\u5353\u7c7b\u836f\u7269\uff08\u5982\u6c2f\u785d\u897f\u6cee\uff09\u4e5f\u5f88\u6709\u6548\u3002\u53ef\u4ee5\u8003\u8651\u6301\u7eed\u6ef4\u6ce8\u52b3\u62c9\u897f\u6cee\u7b49\u82ef\u4e8c\u6c2e\u5353\u7c7b\u836f\u7269\uff0c\u4f46\u53ef\u80fd\u4f1a\u5bfc\u81f4\u4e19\u4e8c\u9187\u4e2d\u6bd2\u3002\u54aa\u8fbe\u5511\u4ed1\u5728\u56de\u8def\u4e2d\u9ad8\u5ea6\u87af\u5408\uff0c\u5e76\u4e0d\u53ef\u9760\u3002\u867d\u7136\u975e\u836f\u7269\u5e72\u9884\u662f\u4e00\u7ebf\u6cbb\u7597\u65b9\u6cd5\uff0c\u4f46\u53f3\u7f8e\u6258\u54aa\u5b9a\u3001\u55b9\u786b\u5e73\u6216\u6c1f\u54cc\u5576\u9187\u88ab\u8ba4\u4e3a\u662f\u6539\u5584\u8c35\u5984\u548c\u8e81\u52a8\u63a7\u5236\u7684\u9996\u9009\u836f\u7269\u3002\u65e5\u5e38\u9547\u9759\u5242\u65ad\u836f\u548c\u6309\u65b9\u6848\u505c\u6b62\u9547\u9759\u5bf9\u4e8e\u6539\u5584\u8fd9\u4e9b\u60a3\u8005\u7684\u603b\u4f53\u9884\u540e\u81f3\u5173\u91cd\u8981\u3002\u7136\u800c\uff0c\u9762\u5bf9\u6df1\u5ea6\u9547\u9759\uff08\u91cc\u58eb\u6ee1\u8e81\u52a8-\u9547\u9759\u91cf\u8868\u4e3a -4 \u81f3 -5\uff09\u4f46\u4ecd\u5b58\u5728\u96be\u6cbb\u6027\u7f3a\u6c27\u7684\u60a3\u8005\uff0c\u5e94\u8003\u8651\u8fdb\u884c\u808c\u677e\u6cbb\u7597\uff0c\u4ee5\u4f18\u5316\u547c\u5438\u673a\u7684\u6548\u679c\u3002\u5efa\u8bae\u7684 ECMO \u671f\u95f4\u9547\u9759\u65b9\u6848\u89c1\u56fe 1\u3002<\/p>\n<\/p>\n<p>\u56fe 1\uff1a\u63cf\u8ff0\u4f53\u5916\u819c\u6c27\u5408\uff08ECMO\uff09\u652f\u6301\u671f\u95f4\u9547\u75db\u5efa\u8bae\u65b9\u6cd5\u7684\u5efa\u8bae\u65b9\u6848\u3002PO = \u53e3\u670d\uff0cRASS = \u91cc\u58eb\u6ee1\u8e81\u52a8\u9547\u9759\u91cf\u8868\uff0cTID = \u6bcf\u5929\u4e09\u6b21\u3002\u3002<\/p>\n<p>\u76ee\u6807\u4f53\u6e29\u7ba1\u7406<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u6700\u8fd1\u7684 ELSO \u6307\u5357\u5efa\u8bae\u5728\u6700\u521d\u7684 24 \u5c0f\u65f6\u5185\u4fdd\u6301\u4f4e\u4f53\u6e29\uff0833-36\u00b0C\uff09\uff0c\u7136\u540e\u9010\u6e10\u590d\u6e29\u81f3 37\u00b0C \u7684\u6b63\u5e38\u4f53\u6e29\u3002\u7136\u800c\uff0c\u5c3d\u7ba1\u6709\u6b64\u5efa\u8bae\uff0c\u6709\u5173\u5176\u5bf9\u9884\u540e\u5f71\u54cd\u7684\u6570\u636e\u5374\u5f88\u5c11\u3002\u4e00\u9879\u968f\u673a\u4e34\u5e8a\u8bd5\u9a8c\uff08RCT\uff09\u8868\u660e\uff0c\u4e0e\u6b63\u5e38\u4f53\u6e29\uff0836-37\u00b0C\uff09\u76f8\u6bd4\uff0c\u5185\u79d1\u5fc3\u6e90\u6027\u4f11\u514b\u60a3\u8005\u9759\u8109\u52a8\u8109 ECMO \u540e\u7684\u65e9\u671f\u4f4e\u4f53\u6e29\uff0833-34\u00b0C\uff09\u5e76\u4e0d\u80fd\u63d0\u9ad8\u5b58\u6d3b\u7387\u3002\u4ee5 ECPR \u4e3a\u91cd\u70b9\u7684\u89c2\u5bdf\u6027\u7814\u7a76\u663e\u793a\uff0c\u5173\u4e8e\u76ee\u6807\u4f53\u6e29\u7ba1\u7406 (TTM) \u5bf9\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u7684\u5f71\u54cd\uff0c\u7ed3\u679c\u76f8\u4e92\u77db\u76fe\u3002\u4f4e\u6e29\u6301\u7eed\u65f6\u95f4\u8f83\u957f\uff0832-36\u00b0C\uff09\u53ef\u80fd\u4e0e\u51fa\u9662\u65f6\u795e\u7ecf\u7cfb\u7edf\u9884\u540e\u7684\u6539\u5584\u6709\u5173\uff0c\u5c3d\u7ba1\u8be5\u7814\u7a76\u53d7\u9650\u4e8e\u5355\u4e2d\u5fc3\u8bbe\u8ba1\u3002\u76ee\u524d\uff0c\u4e00\u9879\u591a\u4e2d\u5fc3 RCT\uff08\u964d\u6e29\u6301\u7eed\u65f6\u95f4\u5bf9\u5fc3\u810f\u9aa4\u505c\u60a3\u8005\u7597\u6548\u7684\u5f71\u54cd\uff09\u7814\u7a76\u6b63\u5728\u8fdb\u884c\u4e2d\uff0c\u8be5\u7814\u7a76\u65e8\u5728\u8c03\u67e5\u9662\u5916 CA \u660f\u8ff7\u5e78\u5b58\u8005 TTM \u7684\u6700\u4f73\u6301\u7eed\u65f6\u95f4\uff0c\u6216\u8bb8\u80fd\u63d0\u4f9b\u4e00\u4e9b\u89c1\u89e3\u3002\u56fe 2 \u5c55\u793a\u4e86\u63d2\u7ba1\u540e\u7684\u5173\u952e\u6b65\u9aa4\u3002<\/p>\n<\/p>\n<p>\u56fe 2\uff1a\u63d2\u7ba1\u540e\u7acb\u5373\u91c7\u53d6\u7684\u6b65\u9aa4\u793a\u610f\u56fe\u3002ECHO=\u8d85\u58f0\u5fc3\u52a8\u56fe\uff0cECMO=\u4f53\u5916\u819c\u80ba\u6c27\u5408\uff0cEKG=\u5fc3\u7535\u56fe\uff0cET=\u6c14\u7ba1\u63d2\u7ba1\uff0cLV=\u5de6\u5fc3\u5ba4\uff0cMAP=\u5e73\u5747\u52a8\u8109\u538b\u3002<\/p>\n<p>\u8425\u517b<\/p>\n<p>&nbsp; &nbsp; &nbsp; ECMO \u60a3\u8005\u7684\u8425\u517b\u652f\u6301\u5f80\u5f80\u9762\u4e34\u591a\u91cd\u6311\u6218\uff0c\u56e0\u4e3a\u624b\u672f\u548c\u8840\u7ba1\u52a0\u538b\u9700\u8981\u9891\u7e41\u4e2d\u65ad\u8fdb\u98df\uff0c\u65e0\u5f20\u529b\u7684\u80a0\u9053\u53ef\u80fd\u9700\u8981\u4f7f\u7528\u4fc3\u52a8\u529b\u836f\u7269\uff0c\u4f46\u8fd9\u4e9b\u836f\u7269\u5f80\u5f80\u65e0\u6548\uff0c\u800c\u4e14\u9700\u8981\u63a8\u8fdf\u8865\u5145\u80a0\u5916\u8425\u517b\u3002ECMO \u60a3\u8005\u5904\u4e8e\u4e25\u91cd\u7684\u5206\u89e3\u4ee3\u8c22\u72b6\u6001\uff0c\u5bfc\u81f4\u80f0\u5c9b\u7d20\u3001\u513f\u8336\u915a\u80fa\u3001\u80f0\u9ad8\u8840\u7cd6\u7d20\u548c\u76ae\u8d28\u9187\u6c34\u5e73\u6301\u7eed\u5347\u9ad8\u3002ECMO \u5f15\u8d77\u7684\u9ad8\u708e\u75c7\u72b6\u6001\u4f1a\u589e\u52a0\u7ec6\u80de\u56e0\u5b50\u6c34\u5e73\uff0c\u5bfc\u81f4\u80fd\u91cf\u6d88\u8017\u8fdb\u4e00\u6b65\u589e\u52a0\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u52a0\u5f3a\u8425\u517b\u5e73\u8861\u7684\u57fa\u672c\u7b56\u7565\u5305\u62ec\uff1a\u5236\u5b9a\u5177\u6709\u5bb9\u91cf\u76ee\u6807\u7684\u65b9\u6848\u4ee5\u53d6\u4ee3\u524d\u4e00\u5929 &#8216;\u9519\u8fc7 &#8216;\u7684\u5582\u98df\uff1b\u653e\u7f6e\u5e7d\u95e8\u540e\u9f3b\u80a0\u7ba1\u4ee5\u964d\u4f4e\u5438\u5165\u548c\u80ba\u708e\u7684\u98ce\u9669\uff08\u5c3d\u7ba1\u6700\u8fd1\u7684\u4e00\u9879\u7814\u7a76\u8868\u660e\u4f7f\u7528\u5e7d\u95e8\u540e\u9f3b\u80a0\u7ba1\u6ca1\u6709\u76ca\u5904\uff09\uff1b\u8003\u8651\u4f7f\u7528\u66f4\u6d53\u7f29\u7684\u914d\u65b9\uff0c\u56e0\u4e3a\u8fd9\u7c7b\u60a3\u8005\u901a\u5e38\u63a5\u53d7\u7684\u7ba1\u9972\u901f\u5ea6\u8f83\u6162\u3002\u503c\u5f97\u6ce8\u610f\u7684\u662f\uff0c\u9700\u8981\u4f7f\u7528\u8840\u7ba1\u52a0\u538b\u5242\u5e76\u4e0d\u8868\u793a\u65e9\u671f\u80a0\u5185\u5582\u517b\u662f\u7981\u5fcc\u75c7\uff0c\u4f46\u968f\u7740\u8840\u7ba1\u52a0\u538b\u5242\u5242\u91cf\u5f53\u91cf\u5206\u6570\u7684\u589e\u52a0\uff0c\u5e94\u8003\u8651\u964d\u4f4e\u7ba1\u9972\u7387\u3002\u4e13\u5bb6\u5171\u8bc6\u5efa\u8bae\u5728 ECMO \u652f\u6301\u7684\u6700\u521d 24 \u5c0f\u65f6\u5185\u5f00\u59cb\u4f7f\u7528\u9ad8\u86cb\u767d\u3001\u4f4e\u7ea4\u7ef4\u914d\u65b9\u7684\u80a0\u5185\u5582\u517b\uff0c\u5f00\u59cb\u65f6\u6bcf\u5c0f\u65f6 10-20 \u6beb\u5347\uff0c\u5728\u63a5\u4e0b\u6765\u7684 24-36 \u5c0f\u65f6\u5185\u6bcf 4 \u5c0f\u65f6\u589e\u52a0\u4e00\u6b21\uff0c\u4ee5\u8fbe\u5230\u76ee\u6807\u5582\u517b\u7387\u3002<\/p>\n<p>\u6297\u51dd<\/p>\n<p>&nbsp; &nbsp; &nbsp; &nbsp;\u867d\u7136\u5404\u673a\u6784\u7684\u65b9\u6848\u5728\u6297\u51dd\u7b56\u7565\u4e0a\u53ef\u80fd\u6709\u6240\u4e0d\u540c\uff0c\u4f46\u5efa\u8bae\u8fdb\u884c\u5168\u8eab\u6297\u51dd\uff0c\u6700\u5e38\u7528\u7684\u836f\u7269\u662f\u975e\u5206\u6570\u809d\u7d20\u3002\u5728\u809d\u7d20\u7981\u5fcc\u75c7\u6216\u809d\u7d20\u62b5\u6297\uff08\u6297\u51dd\u8840\u9176 III \u4f4e\uff09\u7684\u60c5\u51b5\u4e0b\uff0c\u53ef\u4f7f\u7528\u51dd\u8840\u9176\u6291\u5236\u5242\uff08\u5982\u6bd4\u4f10\u5362\u5b9a\uff09\u3002<\/p>\n<p>\u6db2\u4f53\u3001\u7535\u89e3\u8d28\u548c\u8840\u7cd6\u7ba1\u7406<\/p>\n<p>&nbsp; &nbsp; &nbsp; ECMO \u60a3\u8005\u7ecf\u5e38\u51fa\u73b0\u4f53\u6db2\u8d85\u8d1f\u8377\uff0c\u8fd9\u901a\u5e38\u662f\u7531\u4e8e\u6700\u521d\u590d\u82cf\u65f6\u5927\u91cf\u9759\u8109\u8f93\u6db2\u3001\u8f93\u6ce8\u8840\u5236\u54c1\uff0c\u4ee5\u53ca\u5bf9\u8bf1\u53d1\u4e8b\u4ef6\u7684\u5168\u8eab\u708e\u75c7\u53cd\u5e94\uff08\u53ef\u80fd\u6301\u7eed\u6570\u5929\uff09\u5bfc\u81f4\u7684\u6301\u7eed\u4f53\u6db2\u9700\u6c42\u9020\u6210\u7684\u3002\u53ea\u6709\u5728\u8840\u7ba1\u5185\u5bb9\u91cf\u4e0d\u8db3\u7684\u60c5\u51b5\u4e0b\uff0c\u624d\u5e94\u614e\u91cd\u8003\u8651\u8f93\u6db2\u3002\u89c2\u5bdf\u6027\u7814\u7a76\u5f3a\u8c03\uff0cECMO \u7b2c\u4e09\u5929\u7684\u6db2\u4f53\u6b63\u5e73\u8861\u4e0e\u6b7b\u4ea1\u7387\u589e\u52a0\u6709\u5173\u3002\u56e0\u6b64\uff0c\u5728 ECMO \u6d41\u91cf\u8fbe\u5230\u6700\u4f73\u4e14\u60a3\u8005\u8840\u6d41\u52a8\u529b\u5b66\u7a33\u5b9a\u540e\uff0c\u6700\u597d\u4e89\u53d6\u5b9e\u73b0\u6bcf\u65e5\u8d1f\u6db2\u4f53\u5e73\u8861\u3002\u5982\u679c\u8fd9\u4f1a\u5f71\u54cd ECMO \u6d41\u91cf\uff0c\u90a3\u4e48\u663e\u7136\u4ecd\u6709\u5fc5\u8981\u8f93\u6db2\u3002<\/p>\n<p>\u5e76\u53d1\u75c7<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5728 ECPR \u4e2d\uff0cECMO \u5e76\u53d1\u75c7\u7684\u53d1\u751f\u7387\u9ad8\u8fbe 60%\uff0c\u662f\u5f71\u54cd\u5b58\u6d3b\u7387\u7684\u91cd\u8981\u56e0\u7d20\u3002\u8868 2 \u6982\u8ff0\u5e76\u8ba8\u8bba\u4e86\u8fd9\u4e9b\u5e76\u53d1\u75c7\u3002<\/p>\n<\/p>\n<p>\u9884\u540e\u548c\u7ed3\u679c<\/p>\n<p>\u9884\u540e\u56e0\u7d20<\/p>\n<p>&nbsp; &nbsp; &nbsp; ECPR \u60a3\u8005\u901a\u5e38\u4f1a\u51fa\u73b0\u4e25\u91cd\u7684 ABI \u548c\u591a\u5668\u5b98\u8870\u7aed\uff0c\u56e0\u6b64\u603b\u4f53\u9884\u540e\u548c\u7ed3\u679c\u9884\u6d4b\u662f\u91cd\u8981\u7684\u8bfe\u9898\u3002\u4e00\u4e9b\u7814\u7a76\u62a5\u544a\u79f0\uff0c\u53ef\u7535\u51fb\u5fc3\u5f8b\u3001\u63d2\u7ba1\u65f6\u8f83\u9ad8\u7684 pH \u503c\u548c\u8f83\u4f4e\u7684\u8840\u6e05\u4e73\u9178\u6c34\u5e73\u4ee5\u53ca\u8f83\u77ed\u7684\u4f4e\u6d41\u91cf\u6301\u7eed\u65f6\u95f4\uff08\u63d2\u7ba1\u65f6\u95f4\uff09\u4e0e ECPR \u7684\u826f\u597d\u9884\u540e\u76f8\u5173\u3002<\/p>\n<p>\u5f71\u50cf\u5b66<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5efa\u8bae\u5bf9\u6240\u6709 ECPR \u75c5\u4f8b\u8fdb\u884c\u5f71\u50cf\u5b66\u68c0\u67e5\uff0c\u9996\u5148\u8fdb\u884c\u5e8a\u65c1\u8d85\u58f0\u68c0\u67e5\uff0c\u7136\u540e\u8fdb\u884c\u5168\u8eab CT \u68c0\u67e5\u3002\u65e9\u671f\u5e38\u89c4 CT \u626b\u63cf\u53ef\u786e\u5b9a\u67d0\u4e9b CA \u7684\u6f5c\u5728\u539f\u56e0\uff0c\u6700\u9ad8\u53ef\u8fbe 17% \u7684\u60a3\u8005\uff0c\u8bc4\u4f30 ABI \u7684\u4e25\u91cd\u7a0b\u5ea6\uff0c\u68c0\u6d4b\u5f15\u6d41\u4e0d\u7545\u548c ECMO \u6d41\u91cf\u4e0b\u964d\uff08\u5982\u679c\u5b58\u5728\uff09\u7684\u75c5\u56e0\uff0c\u5e76\u8bc4\u4f30\u521d\u59cb CA\u3001\u590d\u82cf\u548c ECMO \u63d2\u7ba1\u5f15\u8d77\u7684\u8840\u6813\/\u51fa\u8840\u5e76\u53d1\u75c7\u3002\u7531\u4e8e ECPR \u60a3\u8005\u7684\u5fc3\u80ba\u590d\u82cf\u65f6\u95f4\u8f83\u957f\uff0c\u5fc3\u80ba\u590d\u82cf\u76f8\u5173\u635f\u4f24\u7684\u53d1\u751f\u7387\u53ef\u80fd\u9ad8\u4e8e\u5e38\u89c4\u5fc3\u80ba\u590d\u82cf\u60a3\u8005\u3002\u65e9\u671f\u7684\u5168\u8eab CT \u626b\u63cf\u53ef\u68c0\u6d4b\u51fa\u9ad8\u8fbe 80% \u7684 CA \u5e78\u5b58\u8005\u7684\u6b64\u7c7b\u635f\u4f24\uff0c\u5305\u62ec\u9aa8\u9abc\u9aa8\u6298\u548c\u5668\u5b98\/\u8840\u7ba1\u635f\u4f24\u3002\u4e00\u65e6\u53d1\u73b0\u8fd9\u4e9b\u635f\u4f24\uff0c\u533b\u62a4\u4eba\u5458\u5e94\u7acb\u5373\u91c7\u53d6\u9002\u5f53\u7684\u5904\u7406\u63aa\u65bd\u3002\u65e9\u671f\u53d1\u73b0 ABI \u548c\u51fa\u8840\u5e76\u53d1\u75c7\u53ef\u51cf\u8f7b\u5b8c\u5168\u6297\u51dd\u6cbb\u7597\u7684\u98ce\u9669\uff0c\u907f\u514d\u52a0\u91cd\u8fd9\u4e9b\u5e76\u53d1\u75c7\u3002\u5982\u679c\u53ef\u4ee5\u5b89\u5168\u8fdb\u884c\uff0c\u65e9\u671f\u5934\u9885 CT \u53ef\u4ee5\u5728 ECPR 24 \u5c0f\u65f6\u5185\u663e\u793a ICH\uff0811%\uff09\u3002<\/p>\n<p>&nbsp; &nbsp; &nbsp;&nbsp;\u867d\u7136\u4f20\u7edf\u7684\u5934\u9885\u90e8\u78c1\u5171\u632f\u6210\u50cf\u5728\u8bca\u65ad ABI \u65b9\u9762\u6bd4\u5934\u9885\u90e8 CT \u654f\u611f\u5f97\u591a\uff0c\u4f46\u5b83\u4e0e ECMO \u7535\u8def\u4e0d\u517c\u5bb9\u3002\u76ee\u524d\u6b63\u5728\u8fdb\u884c\u4e00\u9879\u4e34\u5e8a\u8bd5\u9a8c\uff0c\u7814\u7a76\u5728 ECMO \u60a3\u8005\u4e2d\u4f7f\u7528\u4fbf\u643a\u5f0f\u4f4e\u573a\u8111\u78c1\u5171\u632f\u6210\u50cf\uff0c\u521d\u6b65\u62a5\u544a\u663e\u793a\u5176\u5b89\u5168\u6027\u548c\u53ef\u884c\u6027\u3002<\/p>\n<p>ECMO \u4f5c\u4e3a\u6865\u6881<\/p>\n<p>&nbsp; &nbsp; &nbsp;\u7ea6\u6709 1-3% \u7684 ECMO \u60a3\u8005\u53ef\u901a\u8fc7\u6865\u63a5\u63a5\u53d7\u5fc3\u5ba4\u8f85\u52a9\u88c5\u7f6e (VAD) \u6216\u5fc3\u810f\u79fb\u690d\u3002\u5bf9\u4e8e\u795e\u7ecf\u529f\u80fd\u4fdd\u7559\u4f46\u5fc3\u808c\u6062\u590d\u5ef6\u8fdf\u7684 ECPR \u5e78\u5b58\u8005\uff0c\u5e94\u8fdb\u884c\u8bc4\u4f30\uff0c\u4ee5\u91c7\u53d6\u8fd9\u4e9b\u5e72\u9884\u63aa\u65bd\u3002\u56e0\u6b64\uff0c\u63d0\u4f9b\u8fd9\u4e9b\u9009\u62e9\u7684\u80fd\u529b\u88ab\u8ba4\u4e3a\u662f ECPR \u9879\u76ee\u53d6\u5f97\u6210\u529f\u7684\u5173\u952e\u56e0\u7d20\u3002<\/p>\n<p>\u795e\u7ecf\u76d1\u6d4b<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u5e8a\u65c1\u591a\u6a21\u6001\u795e\u7ecf\u76d1\u6d4b\uff0c\u5982\u795e\u7ecf\u7cfb\u7edf\u68c0\u67e5\u3001\u8111\u7535\u56fe\u3001\u7ecf\u9885\u591a\u666e\u52d2\u8d85\u58f0\u548c\u4f53\u611f\u8bf1\u53d1\u7535\u4f4d\uff0c\u53ef\u65e9\u671f\u53d1\u73b0 ABI \u5e76\u53ca\u65f6\u5e72\u9884 ECMO \u60a3\u8005\u3002\u8fd9\u5bf9\u4e8e\u65e0\u6cd5\u8131\u79bb\u9547\u9759\u6216\u670d\u7528\u9547\u9759\u836f\u7269\u540e\u4ecd\u65e0\u53cd\u5e94\u7684\u60a3\u8005\u5c24\u4e3a\u91cd\u8981\u3002\u7814\u7a76\u5f3a\u8c03\u4e86\u6807\u51c6\u5316\u795e\u7ecf\u76d1\u6d4b\u65b9\u6848\u5728 ECPR \u4e2d\u7684\u91cd\u8981\u6027\uff0c\u56e0\u4e3a\u5b83\u53ef\u4ee5\u63d0\u9ad8 ABI \u7684\u8bca\u65ad\u7387\uff0c\u6539\u5584\u51fa\u9662\u65f6\u7684\u795e\u7ecf\u529f\u80fd\u9884\u540e\u3002<\/p>\n<p>\u64a4\u9500\u7ef4\u6301\u751f\u547d\u7597\u6cd5<\/p>\n<p>&nbsp; &nbsp; &nbsp; ECPR \u60a3\u8005\u5728\u63d2\u7ba1\u65f6\u9884\u540e\u4e0d\u4f73\uff0c\u4f46\u5f53\u51fa\u73b0\u7834\u574f\u6027 ABI\u3001\u591a\u5668\u5b98\u529f\u80fd\u8870\u7aed\uff0c\u6216\u5728\u6ca1\u6709\u79fb\u690d\u6216 VAD \u7b49\u9000\u51fa\u7b56\u7565\u7684\u60c5\u51b5\u4e0b\u5eb7\u590d\u53ef\u80fd\u6027\u4e0d\u5927\u65f6\uff0c\u5c31\u53ef\u4ee5\u8003\u8651\u64a4\u9664\u7ef4\u6301\u751f\u547d\u7597\u6cd5 (WLST)\uff0c\u53d6\u6d88 ECMO \u63d2\u7ba1\u3002\u5bf9 ELSO \u6ce8\u518c\u8868\u7684\u5206\u6790\u8868\u660e\uff0c\u534a\u6570\u4ee5\u4e0a\u7684 ECPR \u60a3\u8005\u5728\u6700\u521d 72 \u5c0f\u65f6\u5185\u7ecf\u5386\u4e86 WLST\u3002ECPR \u4e2d\u7684\u65e9\u671f WLST \u4e0e\u4e25\u91cd\u5371\u91cd\u75c7\u6307\u6807\u6076\u5316\u6709\u5173\uff0c\u5982\u65e9\u671f pH \u503c\u8fc7\u4f4e\u548c\u8840\u6e05\u4e73\u9178\u6c34\u5e73\u8fc7\u9ad8\u3002\u5728\u89e3\u91ca ECPR \u60a3\u8005\u7684\u7ed3\u679c\u6570\u636e\u65f6\u9700\u8981\u8c28\u614e\uff0c\u56e0\u4e3a WLST \u662f\u4e00\u79cd\u81ea\u6211\u5b9e\u73b0\u7684\u9884\u8a00\uff0c\u5c24\u5176\u662f\u5728 ECMO \u63d2\u7ba1\u540e 72 \u5c0f\u65f6\u5185\u51fa\u73b0\u65e9\u671f WLST \u7684\u60c5\u51b5\u975e\u5e38\u666e\u904d\uff0c\u8fd9\u5c31\u4e0d\u53ef\u80fd\u6709\u8db3\u591f\u7684\u65f6\u95f4\u6765\u8bc1\u660e\u4e34\u5e8a\u4e0a\u7684\u663e\u8457\u6062\u590d\u3002\u51b3\u5b9a\u662f\u5426\u8fdb\u884c WLST \u662f\u4e00\u4e2a\u590d\u6742\u7684\u540e\u52e4\u548c\u60c5\u611f\u8fc7\u7a0b\uff0c\u6d89\u53ca\u5305\u62ec\u5bb6\u5ead\u6210\u5458\u5728\u5185\u7684\u591a\u4e2a\u65b9\u9762\u3002\u5b9e\u65bd\u5305\u542b\u59d1\u606f\u6cbb\u7597\u3001\u53ca\u65e9\u9891\u7e41\u53c2\u4e0e\u5bb6\u5c5e\u8ba8\u8bba\u548c\u7cbe\u795e\u652f\u6301\u7684\u6807\u51c6\u5316\u65b9\u6cd5\uff0c\u53ef\u4ee5\u52a0\u5f3a\u6574\u4f53\u6c9f\u901a\uff0c\u6539\u5584 ECPR \u60a3\u8005\u7684\u6cbb\u7597\u6548\u679c\u53ca\u5176\u5bb6\u5c5e\u7684\u4f53\u9a8c\u3002<\/p>\n<p>\u7ed3\u8bba<\/p>\n<p>&nbsp; &nbsp; &nbsp; \u968f\u7740 ECPR \u4f7f\u7528\u8303\u56f4\u7684\u6269\u5927\uff0c\u4f18\u5316\u63d2\u7ba1\u540e\u7684 CA \u540e\u6cbb\u7597\u5bf9\u4e8e\u63d0\u9ad8\u5b58\u6d3b\u7387\u548c\u795e\u7ecf\u529f\u80fd\u9884\u540e\u81f3\u5173\u91cd\u8981\u3002\u9700\u8981\u8fdb\u4e00\u6b65\u5f00\u5c55\u7814\u7a76\uff0c\u63a2\u7d22\u6700\u4f73\u7ba1\u7406\u7b56\u7565\u3001\u786e\u5b9a\u7406\u60f3\u7684\u751f\u7406\u76ee\u6807\u3001\u5b8c\u5584\u9884\u540e\u5de5\u5177\u5e76\u89e3\u51b3\u4f26\u7406\u95ee\u9898\uff0c\u4ece\u800c\u4e3a ECPR \u4e2d\u7684\u63d2\u7ba1\u540e ICU \u7ba1\u7406\u5236\u5b9a\u6807\u51c6\u5316\u6307\u5357\u3002<\/p>\n<p>\u6765\u6e90\uff1a<\/p>\n<ul>\n<li>\n<p>Kang. Post-Cardiac Arrest Care in Adult Patients After Extracorporeal Cardiopulmonary Resuscitation. Crit Care Med 2024;52(3):483-494<\/p>\n<\/li>\n<\/ul>\n<h2>\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u4e13\u5bb6\u5171\u8bc6\u66f4\u65b0\uff082023\u7248\uff09<\/h2>\n<p>\u520a\u7f51\u671f\u4e2d\u534e\u533b\u5b66&nbsp;<\/p>\n<p>\u672c\u6587\u6765\u6e90\uff1a\u4e2d\u534e\u6025\u8bca\u533b\u5b66\u6742\u5fd7, 2023,32(3)&nbsp;: 298-304.<\/p>\n<p>\u9759\u8109-\u52a8\u8109\u4f53\u5916\u819c\u80ba\u6c27\u5408\uff08venous-arterial extracorporeal membrane oxygenation, V-A ECMO\uff09\u5728\u96be\u6cbb\u6027\u5fc3\u810f\u9aa4\u505c\uff08cardiac arrest, CA\uff09\u4e2d\u5df2\u5f97\u5230\u5e7f\u6cdb\u5e94\u7528\u3002\u6211\u56fd\u6025\u8bca\u533b\u5b66\u4e13\u5bb6\u56e2\u961f\u57282018\u5e74\u53d1\u8868\u7684\u300a\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u4e13\u5bb6\u5171\u8bc6\u300b\u4e2d\uff0c\u7cfb\u7edf\u9610\u8ff0\u5b9e\u65bd\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\uff08extracorporeal cardiopulmonary resuscitation, ECPR\uff09\u8fc7\u7a0b\u4e2d\u7684\u5173\u952e\u95ee\u9898\uff0c\u5927\u5927\u63a8\u8fdb\u4e86\u56fd\u5185\u6025\u8bcaECPR\u6280\u672f\u7684\u5f00\u5c55\u3002\u6211\u56fdECPR\u7684\u53d1\u5c55\u8fdc\u672a\u6ee1\u8db3\u4e34\u5e8a\u9700\u6c42\uff0c\u4ecd\u5904\u4e8e\u9ad8\u901f\u53d1\u5c55\u671f\uff0c\u5b58\u5728\u5730\u57df\u4e0d\u5747\u8861\u3001\u90e8\u5206\u533b\u9662\u7f3a\u4e4f\u7ecf\u9a8c\u3001\u5728\u57fa\u7840\u6761\u4ef6\u4e0d\u5177\u5907\u7684\u60c5\u51b5\u4e0b\u6025\u4e8e\u5f00\u5c55\u7b49\u60c5\u51b5\uff0c\u52a0\u4e4bECPR\u53d1\u5c55\u8fc5\u901f\uff0c\u57fa\u4e8e\u4e0a\u8ff0\u60c5\u51b5\uff0c\u672c\u6587\u7ed3\u5408\u65b0\u8fd1\u6587\u732e\u53ca\u4e34\u5e8a\u5b9e\u8df5\u5bf92018\u5e74\u5171\u8bc6\u8fdb\u884c\u8865\u5145\u53ca\u66f4\u65b0\u3002<\/p>\n<p>1\u3000ECPR\u7684\u5e94\u7528\u73b0\u51b5<\/p>\n<\/p>\n<p>\u6b27\u6d32\u3001\u5317\u7f8e\u3001\u65e5\u672c\u548c\u97e9\u56fd\u5bf9ECPR\u7684\u7814\u7a76\u8f83\u4e3a\u9886\u5148\u3002\u6b27\u6d32\u7684\u6ce8\u518c\u7814\u7a76\u663e\u793a2011\u5e745\u6708\u52302018\u5e741\u6708\u95f4\u53d1\u751f\u7684\u53ef\u7591\u5fc3\u6e90\u6027\u9662\u5916\u5fc3\u810f\u9aa4\u505c\uff08out-of-hospital cardiac arrest, OHCA\uff09\u4e2d\u5927\u7ea64%\u7684\u60a3\u8005\u4f7f\u7528\u4e86ECPR\u3002\u622a\u6b622022\u5e7410\u6708\uff0c\u4f53\u5916\u751f\u547d\u652f\u6301\u7ec4\u7ec7\u6ce8\u518c\u7684\u6210\u4ebaECPR\u75c5\u4f8b\u517112 125\u4f8b\uff0c\u5176\u4e2d42%\u7684\u60a3\u8005\u80fd\u6210\u529f\u64a4\u9664V-A ECMO\uff0c30%\u80fd\u591f\u51fa\u9662\u6216\u8005\u7b49\u5019\u81f3\u5668\u5b98\u79fb\u690d\u3002<\/p>\n<p>\u76ee\u524d\u56fd\u5185\u90e8\u5206\u5730\u533a\u5df2\u7ecf\u5efa\u6210\u4e86\u533a\u57df\u6027ECPR\u4e2d\u5fc3\uff0c\u4e14\u83b7\u5f97\u4e86\u826f\u597d\u7684\u6cbb\u7597\u6548\u679c\u3002\u5357\u4eac\u533b\u79d1\u5927\u5b66\u7b2c\u4e00\u9644\u5c5e\u533b\u9662\u6025\u8bca\u4e2d\u5fc32015\u20142022\u5e74OHCA\u60a3\u8005\u51fa\u9662\u5b58\u6d3b\u738722.5%\uff0c\u5b58\u6d3b\u60a3\u8005\u4e2d77.8%\u795e\u7ecf\u529f\u80fd\u9884\u540e\u826f\u597d\u3002\u7136\u800c\uff0c\u90e8\u5206\u533b\u7597\u7ed3\u6784\u6280\u672f\u4e0d\u5168\u9762\u3001\u53d7\u5236\u4e8e\u4f26\u7406\u53ca\u8d39\u7528\u6602\u8d35\u7b49\uff0cECPR\u6280\u672f\u7684\u53d1\u5c55\u4ecd\u5904\u4e8e\u74f6\u9888\u671f\u3002\u5efa\u7acb\u5b8c\u5907\u7684\u5206\u7ea7\u8f6c\u8bca\u673a\u5236\u3001\u505a\u597d\u5b9a\u671f\u4e13\u4e1a\u57f9\u8bad\u3001\u8d44\u8d28\u8ba4\u8bc1\u548c\u540e\u7eed\u8d28\u91cf\u63a7\u5236\u5c06\u6210\u4e3a\u6211\u56fdECPR\u6280\u672f\u5065\u5eb7\u6301\u7eed\u53d1\u5c55\u7684\u5173\u952e\u3002<\/p>\n<p>2\u3000ECPR\u8054\u5408\u5176\u4ed6\u6025\u6551\u6280\u672f\u7684<\/p>\n<p>\u96c6\u675f\u5316\u6cbb\u7597\u53ef\u80fd\u6709\u52a9\u4e8e<\/p>\n<p>\u6539\u5584\u60a3\u8005\u9884\u540e<\/p>\n<\/p>\n<p>ECPR\u5f00\u59cb\u540e\uff0c\u5373\u4f7f\u5c1a\u672a\u6062\u590d\u81ea\u4e3b\u5faa\u73af\uff08return of spontaneous circulation, ROSC\uff09\uff0c\u4f53\u5916\u5faa\u73af\u4ecd\u53ef\u4e3a\u5168\u8eab\u810f\u5668\u63d0\u4f9b\u704c\u6ce8\u3002\u4e0e\u4f20\u7edf\u5fc3\u80ba\u590d\u82cf\uff08cardiopulmonary resuscitation, CPR\uff09\u76f8\u6bd4\uff0cECPR\u80fd\u591f\u63d0\u9ad8\u51a0\u72b6\u52a8\u8109\u7684\u704c\u6ce8\u538b\u3001ROSC\u7387\u4ee5\u53ca\u9664\u98a4\u6210\u529f\u7387\uff0c\u5e76\u4e14\u80fd\u591f\u6539\u5584\u8840\u6d41\u52a8\u529b\u5b66\u72b6\u6001\uff0c\u5982\u9888\u52a8\u8109\u8840\u6d41\u91cf\uff0c\u51cf\u5c11\u5fc3\u808c\u6897\u6b7b\u9762\u79ef\u3002ECPR\u80fd\u591f\u63d0\u4f9b\u5145\u8db3\u7684\u5668\u5b98\u704c\u6ce8\uff0c\u51cf\u5c11\u7f3a\u8840\u7f3a\u6c27\u6027\u8111\u75c5\u7684\u98ce\u9669\u3002<\/p>\n<p>CA\u7684\u6cbb\u7597\u975e\u5e38\u590d\u6742\uff0c\u5f80\u5f80\u6d89\u53ca\u591a\u4e2a\u5b66\u79d1\u7684\u6280\u672f\u4ea4\u53c9\u3002V-A ECMO\u3001\u76ee\u6807\u6e29\u5ea6\u7ba1\u7406\uff08target temperature management, TTM\uff09\u3001\u7ecf\u76ae\u51a0\u72b6\u52a8\u8109\u4ecb\u5165\u6cbb\u7597\uff08percutaneous coronary intervention, PCI\uff09\u7b49\u590d\u6742\u6280\u672f\u5747\u53ef\u5e94\u7528\u4e8eCA\u60a3\u8005\u3002V-A ECMO\u7684\u70ed\u4ea4\u6362\u5668\u4e5f\u80fd\u591f\u5e94\u7528\u4e8eTTM\uff0c\u51cf\u5c11\u518d\u704c\u6ce8\u635f\u4f24\uff0c\u5e76\u51cf\u8f7b\u7ee7\u53d1\u6027\u8111\u635f\u4f24\u3002\u56fd\u5185\u53ca\u56fd\u5916\u5b66\u8005\u5747\u6709\u62a5\u9053ECPR\u8054\u5408TTM\u53ef\u6539\u5584\u96be\u6cbb\u6027CA\u60a3\u8005\u9884\u540e\uff0c\u60a3\u8005\u53d6\u5f97\u826f\u597d\u7684\u795e\u7ecf\u529f\u80fd\u9884\u540e\u3002Pang\u7b49\u7814\u7a76\u4e86TTM\u5728\u63a5\u53d7ECPR\u6cbb\u7597\u7684\u96be\u6cbb\u6027OHCA\u60a3\u8005\u4e2d\u7684\u91cd\u8981\u6027\uff0c\u8fd9\u9879\u56de\u987e\u6027\u7814\u7a76\u663e\u793a\uff0c\u63a5\u53d7ECPR\u548cTTM\u7684\u60a3\u8005\u7684\u51fa\u9662\u5b58\u6d3b\u7387\u548c\u795e\u7ecf\u529f\u80fd\u9884\u540e\u5747\u6709\u663e\u8457\u6539\u5584\u3002\u4e0e\u5e38\u6e29\u4e0b\u7684ECPR\u76f8\u6bd4\uff0c\u4f4e\u6e29\u7ec4\u7684\u795e\u7ecf\u529f\u80fd\u9884\u540e\u8f83\u597d\uff0c\u60a3\u8005\u7684\u51fa\u9662\u5b58\u6d3b\u7387\u66f4\u9ad8\uff0842.9%&nbsp;vs. 15.4%\uff0cP=0.020\uff09\u3002\u4eceCA\u5230\u6e29\u5ea6\u8fbe\u6807\u7684\u65f6\u95f4\u8d8a\u77ed\uff0c\u60a3\u8005\u7684\u795e\u7ecf\u529f\u80fd\u9884\u540e\u8d8a\u597d\u3002\u7531\u4e8eECPR\u80fd\u591f\u63d0\u4f9b\u7a33\u5b9a\u7684\u5168\u8eab\u704c\u6ce8\uff0c\u5373\u4f7f\u53d1\u751f\u6301\u7eed\u6027\u5ba4\u98a4\uff0c\u4f7f\u7528ECPR\u7684\u60a3\u8005\u4e5f\u80fd\u8fdb\u884cPCI\u3002CHEER\u8bd5\u9a8c\u7eb3\u5165\u4e8626\u4f8b30 min\u5185\u672a\u80fdROSC\u7684\u9662\u5185\u5fc3\u810f\u9aa4\u505c\uff08in-hospital cardiac arrest\uff0cIHCA\uff09\u53caOHCA\u60a3\u8005\uff0c\u4f7f\u7528\u673a\u68b0\u5fc3\u80ba\u590d\u82cf\u3001TTM\u3001V-A ECMO\u4ee5\u53ca\u5bf9\u53ef\u7591\u51a0\u72b6\u52a8\u8109\u95ed\u585e\u7684\u60a3\u8005\u8fdb\u884c\u51a0\u8109\u4ecb\u5165\u7b49\u6280\u672f\uff0c\u5176\u4e2d14\u4f8b\u60a3\u8005\u51fa\u9662\u65f6\u795e\u7ecf\u529f\u80fd\u5b8c\u5168\u6062\u590d\u3002\u8fd9\u9879\u7814\u7a76\u63d0\u793aCA\u540e\u5305\u62ecV-A ECMO\u7684\u96c6\u675f\u5316\u6cbb\u7597\u53ef\u80fd\u6709\u6548\u6539\u5584\u60a3\u8005\u9884\u540e\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c11\u3000\u6839\u636eCA\u60a3\u8005\u60c5\u51b5\uff0cECPR\u53ef\u8054\u5408TTM\u3001\u51a0\u72b6\u52a8\u8109\u4ecb\u5165\u6cbb\u7597\u7b49\u5b9e\u65bd\u96c6\u675f\u5316\u6cbb\u7597\uff0c\u4ee5\u671f\u6539\u5584\u60a3\u8005\u9884\u540e\u3002<\/p>\n<p>3\u3000ECPR\u7684\u9002\u5e94\u8bc1\u4e0e\u5e94\u7528\u65f6\u673a<\/p>\n<\/p>\n<p>\u76ee\u524d\u5c1a\u65e0\u7edf\u4e00\u7684ECPR\u9002\u5e94\u8bc1\u30022019\u5e74\u7f8e\u56fd\u5fc3\u810f\u75c5\u534f\u4f1a\uff08AHA\uff09\u6307\u5357\u66f4\u65b0\u4e2d\u6307\u51fa\u76ee\u524d\u6ca1\u6709\u8db3\u591f\u8bc1\u636e\u63a8\u8350CA\u60a3\u8005\u5e38\u89c4\u4f7f\u7528ECPR\uff0c\u4f46\u4f20\u7edfCPR\u5931\u8d25\u4e14\u6709\u719f\u7ec3\u533b\u751f\u5feb\u901f\u5b9e\u65bdECPR\u65f6\u53ef\u5bf9\u9009\u62e9\u7684\u60a3\u8005\u5b9e\u65bdECPR\u3002\u968f\u540e\u57282020\u5e74\uff0cAHA\u6307\u5357\u5bf9ECPR\u7684\u9002\u5e94\u8bc1\u8fdb\u884c\u4e86\u66f4\u65b0\uff1a\u76ee\u524d\u6ca1\u6709\u8db3\u591f\u8bc1\u636e\u652f\u6301\u5bf9CA\u60a3\u8005\u4f7f\u7528ECPR\uff0c\u4f46\u5728\u4e00\u5b9a\u7684\u590d\u82cf\u65f6\u95f4\u7a97\u5185\uff0c\u5bf9\u4e8e\u90a3\u4e9b\u9009\u5b9a\u7684\uff0c\u7531\u4e8e\u53ef\u9006\u539f\u56e0\u5bfc\u81f4\u7684CA\u60a3\u8005\uff0c\u4e13\u4e1a\u4eba\u5458\u53ef\u5c1d\u8bd5ECPR\u8fdb\u884c\u62a2\u6551\u3002<\/p>\n<p>\u76f8\u8f832018\u5e74\u300a\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u4e13\u5bb6\u5171\u8bc6\u300b\uff0c\u672c\u671f\u4e13\u5bb6\u5171\u8bc6\u66f4\u63a8\u8350\u521d\u59cb\u5fc3\u5f8b\u4e3a\u5ba4\u901f\/\u5ba4\u98a4\uff08ventricular tachycardia\/ventricular fibrillation, VT\/VF\uff09\u7684\u53ef\u7535\u51fb\u5fc3\u5f8b\u7684CA\u60a3\u8005\u4f7f\u7528ECPR\u6cbb\u7597\u3002Maeda\u7b49\u53d1\u73b0\uff0cECPR\u8f6c\u673a\u524d\u5fc3\u5f8b\u4e3a\u975e\u53ef\u7535\u51fb\u5fc3\u5f8b\u7684\u60a3\u8005\uff0c\u5176\u9662\u5185\u75c5\u6b7b\u7387\u660e\u663e\u9ad8\u4e8eECPR\u8f6c\u673a\u524d\u5fc3\u5f8b\u4e3a\u53ef\u7535\u51fb\u5fc3\u5f8b\u7684\u60a3\u8005\uff08OR=5.42\uff0c95%CI\uff1a2.11~15.36\uff1bP&lt;0.001\uff09\u3002Kawashima\u7b49\u53d1\u73b0\u521d\u59cb\u5fc3\u5f8b\u4e3aVT\/VF\u7684CA\u60a3\u8005\u5b9e\u65bdECPR\u53ef\u4ea7\u751f3.32\u8d28\u91cf\u8c03\u6574\u751f\u547d\u5e74\uff0c\u521d\u59cb\u5fc3\u5f8b\u4e3a\u5fc3\u810f\u505c\u640f\/\u65e0\u8109\u7535\u6d3b\u52a8\u7684CA\u60a3\u8005\u5b9e\u65bdECPR\u53ea\u4ea7\u751f1.17\u8d28\u91cf\u8c03\u6574\u751f\u547d\u5e74\uff0c\u800c\u540e\u8005\u7684\u82b1\u8d39\u662f\u524d\u8005\u7684\u4e24\u500d\u5de6\u53f3\u3002\u8fd9\u4e9b\u7814\u7a76\u63d0\u793a\u521d\u59cb\u5fc3\u5f8b\u4e3aVT\/VF\u7684CA\u60a3\u8005\u53ef\u80fd\u83b7\u5f97\u66f4\u597d\u7684\u6210\u672c\u6548\u76ca\u6bd4\u3002<\/p>\n<p>\u7f29\u77edCA\u60a3\u8005\u4f4e\u6d41\u91cf\u65f6\u95f4\u6709\u5229\u4e8e\u6539\u5584\u60a3\u8005\u5b58\u6d3b\u53ca\u795e\u7ecf\u529f\u80fd\u9884\u540e\u3002Lauridsen\u7b49\u7814\u7a76\u53d1\u73b0ECPR\u524d\u6682\u505c\u7684\u80f8\u5916\u6309\u538b\u65f6\u95f4\u6bcf\u589e\u52a05 s\uff0c\u8be5\u60a3\u8005\u7684\u751f\u5b58\u7387\u53ca\u795e\u7ecf\u529f\u80fd\u9884\u540e\u90fd\u968f\u4e4b\u663e\u8457\u6076\u5316\u3002Yukawa\u7b49\u53d1\u73b0OHCA\u60a3\u8005\u83b7\u5f97\u826f\u597d\u795e\u7ecf\u529f\u80fd\u4e0e\u4eceCA\u5230V-A ECMO\u7684\u65f6\u95f4\u660e\u663e\u7f29\u77ed\u5bc6\u5207\u76f8\u5173\uff08\u4e2d\u4f4d\u65f6\u95f433 min&nbsp;vs.&nbsp;46 min\uff09\u3002\u5f53CA\u5230ECMO\u65f6\u95f4\u8d85\u8fc740 min\u65f6\uff0c\u826f\u597d\u795e\u7ecf\u529f\u80fd\u9884\u540e\u7684\u751f\u5b58\u7387\u4ece30%\u4ee5\u4e0a\u8fc5\u901f\u4e0b\u964d\u5230\u7ea615%\u3002\u56e0\u6b64\uff0c\u6700\u4f73OHCA\u5230V-A ECMO\u65f6\u95f4\u7684\u754c\u503c\u53ef\u80fd\u4e3a40 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ECMO\u548cIABP\u7684\u7ec4\u5408\uff0c\u4f46IABP\u5bf9\u795e\u7ecf\u529f\u80fd\u662f\u5426\u6709\u4fdd\u62a4\u4f5c\u7528\u5c1a\u4e0d\u660e\u786e\u3002<\/p>\n<p>\u5bb9\u91cf\u4f18\u5316\u7ba1\u7406\u5728ECPR\u8fd0\u884c\u671f\u95f4\u81f3\u5173\u91cd\u8981\uff0c\u4e00\u65e6\u542f\u52a8V-A ECMO\uff0c\u5c31\u5e94\u5f53\u7acb\u5373\u542f\u52a8\u5bb9\u91cf\u4f18\u5316\u7b56\u7565\u3002\u901a\u8fc7\u4f7f\u7528\u80be\u810f\u66ff\u4ee3\u6cbb\u7597\uff08renal replacement therapy, RRT\uff09\u53ef\u4ee5\u83b7\u5f97\u6700\u4f73\u7684\u6db2\u4f53\u72b6\u6001\uff0cV-A ECMO\u8054\u5408RRT\u662fCA\u60a3\u8005\u7684\u91cd\u8981\u6cbb\u7597\u624b\u6bb5\u3002V-A ECMO\u652f\u6301\u7684\u60a3\u8005\u82e5\u9700\u8981RRT\uff0c\u53ef\u76f4\u63a5\u5c06\u900f\u6790\u8fc7\u6ee4\u5668\u8fde\u81f3V-A ECMO\u56de\u8def\u4e2d\uff0c\u80fd\u591f\u4e3aCA\u60a3\u8005\u63d0\u4f9b\u9ad8\u6548\u7684\u5e8a\u65c1\u652f\u6301\u6cbb\u7597\u3002\u5728\u4fc3\u8fdb\u547c\u5438\u3001\u5faa\u73af\u7cfb\u7edf\u6062\u590d\u7684\u540c\u65f6\uff0c\u6e05\u9664\u673a\u4f53\u5185\u6bd2\u7d20\u4e0e\u591a\u4f59\u6c34\u5206\uff0c\u8fbe\u5230\u51cf\u8f7b\u5fc3\u80ba\u8d1f\u62c5\uff0c\u4fc3\u8fdb\u5404\u810f\u5668\u529f\u80fd\u6062\u590d\u7684\u76ee\u7684\uff0c\u4f46\u4e5f\u4f1a\u589e\u52a0\u611f\u67d3\u3001\u8840\u6813\u5f62\u6210\u548c\u51fa\u8840\u7b49\u5e76\u53d1\u75c7\u7684\u98ce\u9669\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c17\u3000V-A ECMO\u60a3\u8005\u5982\u51fa\u73b0\u5de6\u5fc3\u5ba4\u540e\u8d1f\u8377\u660e\u663e\u589e\u52a0\uff0c\u53ef\u9009\u62e9\u4f7f\u7528IABP\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c18\u3000\u53ef\u4f7f\u7528RRT\u5728ECMO\u8fd0\u884c\u671f\u95f4\u4f18\u5316\u5bb9\u91cf\u7ba1\u7406\u3002<\/p>\n<p>8\u3000ECMO\u7684\u64a4\u673a<\/p>\n<\/p>\n<p>\u64a4\u9664V-A ECMO\u7684\u51b3\u7b56\u9700\u8981\u4e00\u7cfb\u5217\u8003\u91cf\uff0c\u5305\u62ec\u60a3\u8005\u4e34\u5e8a\u75c7\u72b6\u3001\u751f\u547d\u4f53\u5f81\u3001\u8840\u6d41\u52a8\u529b\u5b66\u548c\u5f71\u50cf\u5b66\u662f\u5426\u597d\u8f6c\uff0c\u540c\u65f6\u9700\u8981\u5c3d\u53ef\u80fd\u89e3\u51b3CA\u7684\u6f5c\u5728\u75c5\u56e0\u3002\u96be\u6cbb\u6027VT\/VF\u4e2d\u4e25\u91cd\u51a0\u72b6\u52a8\u8109\u75be\u75c5\u662f\u5927\u591a\u6570\u60a3\u8005CA\u7684\u75c5\u56e0\u3002\u56e0\u6b64\uff0c\u5fc3\u810f\u529f\u80fd\u6062\u590d\u901a\u5e38\u662fV-A ECMO\u62d4\u7ba1\u7684\u6838\u5fc3\u6807\u51c6\u3002\u5177\u4f53\u64a4\u673a\u6807\u51c6\u53ef\u53c2\u71672018\u7248\u300a\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u4e13\u5bb6\u5171\u8bc6\u300b\u3002\u53ef\u4ee5\u91c7\u7528\u964d\u4f4e\u6d41\u91cf\u3001\u5efa\u7acb\u4fa7\u679d\u5faa\u73af\u3001\u6cf5\u63a7\u9006\u6d41\u8bd5\u9a8c\u7b49\u65b9\u6cd5\u8fdb\u884c\u8131\u673a\u8bd5\u9a8c\u3002\u4e73\u9178&gt;24 mmol\/L\u6216\u8005\u4e73\u9178&gt;16 mmol\/L\u4e14pH&lt;6.828\u53ef\u4f5c\u4e3a\u7ec8\u6b62\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u7684\u4e00\u9879\u6307\u6807\u3002<\/p>\n<p>9\u3000ECPR\u7684\u5e76\u53d1\u75c7<\/p>\n<\/p>\n<p>\u96642018\u7248\u300a\u6210\u4eba\u4f53\u5916\u5fc3\u80ba\u590d\u82cf\u4e13\u5bb6\u5171\u8bc6\u300b\u6240\u9610\u8ff0ECPR\u7684\u5e76\u53d1\u75c7\u5916\uff0c&#8217;\u5357\u5317\u7efc\u5408\u5f81&#8217;\u662f\u5916\u5468V-A ECMO\u6cbb\u7597\u7684\u7279\u6709\u5e76\u53d1\u75c7\u3002V-A ECMO\u4e00\u822c\u9009\u62e9\u80a1\u9759\u8109\u4f5c\u4e3a\u5f15\u6d41\u901a\u8def\uff0c\u80a1\u52a8\u8109\u4f5c\u4e3a\u704c\u6ce8\u901a\u8def\uff0c\u5fc3\u810f\u6cf5\u51fa\u7684\u987a\u5411\u8840\u6d41\u4e0e\u5916\u5468V-A ECMO\u7684\u9006\u5411\u8840\u6d41\u5b58\u5728\u4ea4\u4f1a\u5e73\u9762\u3002\u6c27\u5408\u5145\u5206\u7684\u9006\u5411\u8840\u5f80\u5f80\u5f88\u96be\u4f9b\u5e94\u673a\u4f53\u4e0a\u534a\u8eab\uff0c\u800c\u987a\u5411\u8840\u6d41\u6c27\u5408\u4e0d\u826f\uff0c\u5bfc\u81f4\u673a\u4f53\u51fa\u73b0\u4e0a\u534a\u8eab\u7f3a\u6c27\uff0c\u5f71\u54cd\u91cd\u8981\u810f\u5668\u4f9b\u6c27\uff0c\u53ef\u5bfc\u81f4\u8111\u7f3a\u8840\u53ca\u5fc3\u808c\u7f3a\u8840\uff0c\u5c06\u8fd9\u79cd\u5e76\u53d1\u75c7\u79f0\u4e3a&#8217;\u5357\u5317\u7efc\u5408\u5f81&#8217;\uff08\u53c8\u79f0\u4e3aHarlequin\u7efc\u5408\u5f81\u6216BlueHead\u7efc\u5408\u5f81\uff09\u3002\u5357\u5317\u7efc\u5408\u5f81\u901a\u5e38\u53d1\u751f\u5728\u5fc3\u810f\u672c\u8eab\u7684\u6536\u7f29\u80fd\u529b\u9010\u6e10\u6062\u590d\u7684\u8fc7\u7a0b\u4e2d\u3002\u53ef\u4f7f\u7528\u8109\u640f\u8840\u6c27\u9971\u548c\u5ea6\u6d4b\u5b9a\u6cd5\u6216\u52a8\u8109\u8840\u6c14\u6d4b\u91cf\u6cd5\u5bc6\u5207\u76d1\u6d4b\u5934\u81c2\u52a8\u8109\uff0c\u5982\u53f3\u624b\u3001\u624b\u81c2\u6216\u9762\u90e8\u7684\u8840\u6c27\u9971\u548c\u5ea6\u3002\u5728\u5927\u591a\u6570\u60c5\u51b5\u4e0b\uff0c&#8217;\u5357\u5317\u7efc\u5408\u5f81&#8217;\u53ef\u4ee5\u901a\u8fc7\u8c03\u6574\u547c\u5438\u673a\u53c2\u6570\uff08\u5982\u63d0\u9ad8\u547c\u5438\u673a\u5438\u5165\u6c27\u4f53\u79ef\u5206\u6570\u3001\u589e\u52a0\u547c\u5438\u673a\u547c\u6c14\u672b\u6b63\u538b\u7b49\uff09\u6539\u5584\u987a\u884c\u8840\u6db2\u7684\u6c27\u5408\u6765\u9884\u9632\u3002\u6216\u8005\u53ef\u6dfb\u52a0\u5355\u72ec\u7684\u9759\u8109\u704c\u6ce8\u5957\u7ba1\uff0c\u4ee5\u521b\u5efa\u9759\u8109-\u52a8\u8109-\u9759\u8109ECMO\u56de\u8def\u3002<\/p>\n<p>\u6cf5\u8840\u6813\u5f62\u6210\u662f\u4e00\u4e2a\u7f55\u89c1\u4f46\u5f80\u5f80\u5bfc\u81f4\u707e\u96be\u4e8b\u4ef6\u7684\u5e76\u53d1\u75c7\uff0c\u53ef\u80fd\u53d1\u751f\u5728\u6cf5\u5934\u5904\uff0c\u5bfc\u81f4\u4e25\u91cd\u6eb6\u8840\u3001\u8840\u6d41\u52a8\u529b\u5b66\u652f\u6301\u5931\u8d25\u548c\u6b7b\u4ea1\u3002\u52a8\u8109\u4fa7\u56de\u8def\u7684\u4efb\u4f55\u8840\u6813\u90fd\u53ef\u80fd\u5bfc\u81f4\u4f53\u5faa\u73af\u548c\u80ba\u5faa\u73af\u7684\u6813\u585e\u4e8b\u4ef6\u3002<\/p>\n<p>\u63a8\u8350\u610f\u89c19\u3000\u53f3\u4e0a\u80a2\u8109\u6c27\u76d1\u6d4b\u6709\u52a9\u4e8e\u65e9\u671f\u53d1\u73b0&#8217;\u5357\u5317\u7efc\u5408\u5f81&#8217;\uff0c\u8c03\u6574\u547c\u5438\u673a\u53c2\u6570\u6539\u5584\u987a\u884c\u8840\u6d41\u7684\u6c27\u5408\u53ef\u9884\u9632&#8217;\u5357\u5317\u7efc\u5408\u5f81&#8217;\u3002<\/p>\n<p>10\u3000ECPR\u60a3\u8005\u7684\u9884\u540e<\/p>\n<p>\u53ca\u5176\u8bc4\u4f30\u65b9\u6cd5<\/p>\n<\/p>\n<p>\u76ee\u524d\u6574\u4f53\u800c\u8a00\uff0cECPR\u53ef\u4ee5\u63d0\u9ad8CA\u60a3\u8005\u7684\u751f\u5b58\u7387\u548c\u795e\u7ecf\u529f\u80fd\u9884\u540e\u3002\u9488\u5bf9\u96be\u6cbb\u6027OHCA\u60a3\u8005\u7684ECPR\u7814\u7a76\u7ed3\u679c\u663e\u793a\uff0cECPR\u53ef\u63d0\u9ad8\u96be\u6cbb\u6027OHCA\u7684\u751f\u5b58\u7387\u3002\u6839\u636e5\u4e2a\u6b27\u6d32\u533b\u5b66\u4e2d\u5fc3\u7684\u7814\u7a76\u6570\u636e\uff0c\u5728\u672a\u7ecf\u9009\u62e9\u800c\u4f7f\u7528ECPR\u7684CA\u60a3\u8005\u4e2d\uff0c19%\u7684\u60a3\u8005\u62e5\u6709\u8f83\u597d\u7684\u795e\u7ecf\u529f\u80fd\u9884\u540e\uff0c\u800c\u7ecf\u8fc7\u7279\u5b9a\u6807\u51c6\u9009\u62e9\u540e\uff0c38%\u7684CA\u60a3\u8005\u53ef\u4ee5\u8f83\u597d\u5730\u6062\u590d\u795e\u7ecf\u529f\u80fd\u30022015\u5e74\u660e\u5c3c\u82cf\u8fbe\u590d\u82cf\u4e2d\u5fc3\u62a5\u9053\u4e86\u4e00\u9879\u9488\u5bf9VT\/VF\u7684OHCA\u60a3\u8005\u7684\u4e34\u5e8a\u5b9e\u9a8c\u3002\u5728\u8be5\u5b9e\u9a8c\u4e2d\uff0c\u9700\u8981\u5c06\u60a3\u8005\u4eceCA\u7684\u53d1\u751f\u5730\u70b9\u8fc5\u901f\u8f6c\u79fb\u81f3\u660e\u5c3c\u82cf\u8fbe\u5927\u5b66\uff0c\u9014\u4e2d\u6301\u7eed\u8fdb\u884cCPR\u5e76\u5728\u5fc3\u810f\u5bfc\u7ba1\u5ba4\u5f00\u59cbECPR\uff0c\u5982\u679c\u51a0\u8109\u9020\u5f71\u63d0\u793a\u51a0\u8109\u590d\u6742\u75c5\u53d8\uff0c\u9700\u8981\u8fdb\u884cPCI\u3002\u8fd9\u4e00\u5305\u62ecECPR\u548c\u51a0\u8109\u9020\u5f71\u7684\u7a0b\u5e8f\u5316\u7b56\u7565\u80fd\u591f\u663e\u8457\u63d0\u9ad8\u60a3\u8005\u7684\u751f\u5b58\u7387\u548c\u795e\u7ecf\u529f\u80fd\u9884\u540e\uff0c\u6700\u4e2d55%\u7684\u60a3\u8005\u80fd\u591f\u5b58\u6d3b\u81f3\u51fa\u9662\uff0c50%\u7684\u60a3\u8005\u80fd\u591f\u8fbe\u5230\u8111\u529f\u80fd\u8868\u73b0\u5206\u7ea7\uff08cerebral performance 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