身体外支持与心肺系统之间的相互作用
Kaspar F Bachmann1,2, David Berger1, Per Werner Moller3
1Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Frontiers in physiology
|September 29, 2023
概括
外体疗法对心肺生理有深远的影响. 了解这些相互作用对于优化静脉动脉ECMO和静脉静脉ECMO患者的护理和管理至关重要.
科学领域:
- 心肺生理学 心肺生理学
- 身体外膜氧化 (ECMO) 是一种方法.
- 关键护理医学 关键护理医学
背景情况:
- 外体疗法,包括静脉-动脉ECMO和静脉-静脉ECMO,显著改变心血管和肺功能.
- 临床医生需要对这些生理相互作用有深入的了解,以便有效地管理患者.
- 目前对于各种ECMO配置的最佳设置和管理策略存在知识差距.
研究的目的:
- 审查与体外疗法相关的复杂生理相互作用,重点关注心肺关系.
- 要突出静脉动脉ECMO对右心室和左心室功能以及肺血液动力学的影响.
- 确定未来研究领域,以推进体外疗法的理解和应用.
主要方法:
- 对体外膜氧化的生理影响现有文献的综述.
- 对静脉动脉ECMO对左心室余负荷和右心室卸载的影响分析.
- 讨论静脉ECMO的挑战和考虑,包括呼吸机和设备设置.
- 探索右心脏功能,本土气体交换和末尾呼气肺体积的作用.
主要成果:
- 静脉动脉ECMO可以增加左心室后负载,可能导致LV衰竭和肺.
- 静脉ECMO带来了独特的挑战,未定义的最佳设备和通风器设置.
- 了解对右心功能和天然气交换的影响对于临床实践至关重要.
结论:
- 除了以死亡率为重点的试验之外,还需要进行进一步的研究,以解决体外治疗中的生理问题.
- 未来的研究应该调查VV ECMO的最佳设备和通风器设置,并标准化监测策略.
- 计算建模和较小的人/动物研究可以为优化体外治疗管理提供宝贵的见解.
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