2023 年第 5 期 第 18 卷

静脉-动脉体外膜氧合治疗心源性休克患者左心室卸载的临床研究进展

Clinical research progress of left ventricular unloading in veno-arterial extracorporeal membrane oxygenation patients with cardiogenic shock

作者：钟学洪1李佩骏2梁媛3吴成龙3刘子由4

英文作者：Zhong Xuehong1 Li Peijun2 Liang Yuan3 Wu Chenglong3 Liu Ziyou4

单位：1赣南医学院第一临床医学院2020级心胸外科专业型硕士研究生，赣州341000；2湖南省儿童医院心胸外科，长沙410000；3赣南医学院第一临床医学院2021级心胸外科专业型硕士研究生，赣州341000；4赣南医学院第一附属医院心脏医学中心，赣州341000

英文单位：1Professional Master of Cardiothoracic Surgery Grade 2020 First Clinical College of Gannan Medical University Ganzhou 341000 China; 2Department of Cardiothoracic Surgery Hunan Children′s Hospital Changsha 410000 China; 3Professional Master of Cardiothoracic Surgery Grade 2021 First Clinical College of Gannan Medical University Ganzhou 341000 China; 4Cardiac Medical Center First Affiliated Hospital of Gannan Medical University Ganzhou 341000 China

关键词：心源性休克；体外膜氧合；左心室卸载

英文关键词：Cardiogenicshock;Extracorporealmembraneoxygenation;Leftventricularunloading

• 摘要：

• 静脉-动脉体外膜氧合（VA-ECMO）在循环功能衰竭或呼吸功能衰竭患者的生命支持中具有极其广阔的应用前景，能有效改善低氧血症，增加心排血量，改善全身血流灌注，保证循环稳定。由于VA-ECMO在心源性休克患者中能够替代大部分的心脏泵功能，维持全身血流灌注，使心脏得以休息，目前成为终末期心力衰竭患者等待心脏移植以及长期心室机械辅助的过渡替代手段。但VA-ECMO为经股动脉回输血液，属于逆行灌注，与心脏泵血方向相反，增加心脏后负荷，使左心泵血困难，严重心力衰竭患者可出现左心室收缩乏力甚至停滞，致使左心室容量排出受阻，可能导致左心室扩张、肺水肿、电风暴、心肌缺血、肺动脉高压等。本文对VA-ECMO治疗心源性休克患者左心室卸载的临床研究进展进行综述。

• Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) has a very broad application prospect of the life support in patients with circulatory failure or respiratory failure. It can effectively improve hypoxemia, increase cardiac output, improve systemic blood perfusion and ensure circulatory stability. Because VA-ECMO can replace most of the cardiac pump function in patients with cardiogenic shock, maintain systemic blood perfusion and allow the heart to rest, it has become a transitional alternative for patients with end-stage heart failure waiting for heart transplantation and long-term ventricular mechanical assistance. However, VA-ECMO transfusing blood through the femoral artery belongs to retrograde perfusion, which is opposite to the direction of cardiac pumping, increasing the cardiac afterload and making it difficult to pump blood in the left ventricle. Left ventricular systolic weakness or even stagnation may occur in patients with severe heart failure. As a result, the excretion of left ventricular volume is blocked, and may lead to left ventricular dilatation, pulmonary edema, electrical storm, myocardial ischemia, pulmonary hypertension, etc. This paper reviews the clinical research progress of left ventricular unloading in VA-ECMO patients with cardiogenic shock.