连续性肾脏替代治疗嵌入体外膜肺氧合管路连接方式的研究进展

doi:10.3761/j.issn.0254-1769.2022.07.007

摘要/Abstract

摘要：

体外膜肺氧合联合连续性肾脏替代治疗能有效改善和预防液体过负荷、清除炎症介质,提高危重患者的抢救成功率。该文介绍了连续性肾脏替代治疗嵌入体外膜肺氧合管路的不同连接方式的优缺点、护理操作及其风险,提出结合患者病情选择最佳连接模式,减少相关并发症的发生,为连续性肾脏替代治疗嵌入体外膜肺氧合患者的护理提供参考。

关键词: 连续性肾脏替代治疗, 体外膜肺氧合, 重症监护病房, 管路连接, 综述

Abstract:

Extracorporeal membrane oxygenation（ECMO） combined with continuous renal replacement therapy（CRRT） can effectively improve and prevent fluid overload,remove inflammatory mediators,and improve the success rate of rescue for critically ill patients. In this review,the advantages and disadvantages of different modes of CRRT embedded in ECMO were introduced,as well as the nursing operation and risks. It was suggested that the best connection mode should be selected according to the patient’s condition in order to reduce the incidence of related complications,and to provide references for the nursing of extracorporeal membrane pulmonary oxygenation combined with CRRT.

Key words: Continuous Renal Replacement Therapy, Extracorporeal Membrane Oxygenation, Intensive Care Unit, Tube Connection, Review

王庆云, 肖素飞, 卢嫦清, 何军, 周姓良. 连续性肾脏替代治疗嵌入体外膜肺氧合管路连接方式的研究进展[J]. 中华护理杂志, 2022, 57(7): 811-815.

WANG Qingyun, XIAO Sufei, LU Changqing, HE Jun, ZHOU Xingliang. Continuous renal replacement therapy embedded in extracorporeal membrane oxygenation：a review[J]. Chinese Journal of Nursing, 2022, 57(7): 811-815.

图/表 1

参考文献 34

[1]	Askenazi DJ, Selewski DT, Paden ML, et al. Renal replacement therapy in critically ill patients receiving extracorporeal membrane oxygenation[J]. Clin J Am Soc Nephrol, 2012, 7(8):1328-1336. DOI URL
[2]	血液净化急诊临床应用专家共识组. 血液净化急诊临床应用专家共识[J]. 中华急诊医学杂志, 2017, 26(1):24-36.
	Expert Consensus Group on Clinical Application of Blood Purification in Emergency Department. Expert consensus on clinical application of blood purification in emergency department[J]. Chin J Emerg Med, 2017, 26(1):24-36.
[3]	Chen H, Yu RG, Yin NN, et al. Combination of extracorporeal membrane oxygenation and continuous renal replacement therapy in critically ill patients:a systematic review[J]. Crit Care, 2014, 18(6):675. DOI URL
[4]	中国心胸血管麻醉学会, 中华医学会麻醉学分会, 中国医师协会麻醉学医师分会, 等. 不同情况下成人体外膜肺氧合临床应用专家共识(2020版)[J]. 中国循环杂志, 2020, 35(11):1052-1063.
	Chinese Society of Cardiothoracic and Vascular Anesthesiology,Chinese Society of Anesthesiology, Chinese Association of Anesthesiologists, Chinese Thoracic Society,Chinese Society of Critical Care Medicine. Expert consensus on the clinical application of adult extracorporeal membrane oxygenation under different conditions(2020 edition)[J]. Chin Cire J, 2020, 35(11):1052-1063.
[5]	Symons JM, McMahon MW, Karamlou T, et al. Continuous renal replacement therapy with an automated monitor is superior to a free-flow system during extracorporeal life support[J]. Pediatr Crit Care Med, 2013, 14(9):e404-e408. DOI URL
[6]	Dado DN, Ainsworth CR, Thomas SB, et al. Outcomes among patients treated with renal replacement therapy during extracorporeal membrane oxygenation:a single-center retrospective study[J]. Blood Purif, 2020, 49(3):341-347. DOI URL
[7]	Fleming GM, Askenazi DJ, Bridges BC, et al. A multicenter international survey of renal supportive therapy during ECMO:the Kidney Intervention During Extracorporeal Membrane Oxygenation(KIDMO) group[J]. Asaio J, 2012, 58(4):407-414. DOI URL
[8]	Ostermann M, Connor M, Kashani K. Continuous renal replacement therapy during extracorporeal membrane oxygenation:why,when and how?[J]. Curr Opin Crit Care, 2018, 24(6):493-503. DOI PMID
[9]	Shum HP, Kwan AM, Chan KC, et al. The use of regional citrate anticoagulation continuous venovenous hemofiltration in extracorporeal membrane oxygenation[J]. Asaio J, 2014, 60(4):413-418. DOI URL
[10]	Seczyńska B, Królikowski W, Nowak I, et al. Continuous renal replacement therapy during extracorporeal membrane oxygenation in patients treated in medical intensive care unit:technical considerations[J]. Ther Apher Dial, 2014, 18(6):523-534. DOI URL
[11]	Yetimakman AF, Tanyildiz M, Kesici S, et al. Continuous renal replacement therapy applications on extracorporeal membrane oxygenation circuit[J]. Indian J Crit Care Med, 2017, 21(6):355-358. DOI URL
[12]	Annich GM, Lynch WR, MacLaren G, et al. ECMO extracorporeal cardiopulmonary support in critical care 4th[M]. Ann Arbor,MI:ELSO, 2012:189-204.
[13]	Yap HJ, Chen YC, Fang JT, et al. Combination of continuous renal replacement therapies(CRRT) and extracorporeal membrane oxygenation(ECMO) for advanced cardiac patients[J]. Ren Fail, 2003, 25(2):183-193. DOI URL
[14]	Thajudeen B, Kamel M, Arumugam C, et al. Outcome of patients on combined extracorporeal membrane oxygenation and continuous renal replacement therapy:a retrospective study[J]. Int J Artif Organs, 2015, 38(3):133-137. DOI PMID
[15]	Jacobs R, Honore PM, Spapen HD. Intertwining extracorporeal membrane oxygenation and continuous renal replacement therapy:sense or nonsense?[J]. Crit Care, 2015, 19:145. DOI URL
[16]	Suga N, Matsumura Y, Abe R, et al. A safe procedure for connecting a continuous renal replacement therapy device into an extracorporeal membrane oxygenation circuit[J]. J Artif Organs, 2017, 20(2):125-131. DOI URL
[17]	Na SJ, Choi HJ, Chung CR, et al. Using additional pressure control lines when connecting a continuous renal replacement therapy device to an extracorporeal membrane oxygenation circuit[J]. BMC Nephrol, 2018, 19(1):369. DOI URL
[18]	Santiago MJ, Sánchez A, López-Herce J, et al. The use of continuous renal replacement therapy in series with extracorporeal membrane oxygenation[J]. Kidney Int, 2009, 76(12):1289-1292. DOI PMID
[19]	de Tymowski C, Augustin P, Houissa H, et al. CRRT connected to ECMO:managing high pressures[J]. Asaio J, 2017, 63(1):48-52. DOI URL
[20]	Zhou XL, Chen YH, Wang QY. A new approach combining venoarterial extracorporeal membrane oxygenation and CRRT for adults:a retrospective study[J]. Int J Artif Organs, 2017, 40(7):345-349. DOI URL
[21]	Rubin S, Poncet A, Wynckel A, et al. How to perform a haemo-dialysis using the arterial and venous lines of an extracorporeal life support[J]. Eur J Cardiothorac Surg, 2010, 37(4):967-968. DOI URL
[22]	陈丽花, 谢派玲, 曾丽婷, 等. 体外膜肺氧合联合连续性肾脏替代治疗的连接方式及护理[J]. 护理研究, 2020, 34(18):3355-3358.
	Chen LH, Xie PL, Zeng LT, et al. Connection methods and nursing care of extracorporeal membrane oxygenation combined with continuous renal replacement therapy[J]. Chin Nurs Res, 2020, 34(18):3355-3358.
[23]	左文青, 张卫, 林芳, 等. 体外膜肺氧合联合连续性肾脏替代治疗患者局部行枸橼酸抗凝的护理[J]. 中华急危重症护理杂志, 2020, 1(3):238-240.
	Zuo WQ, Zhang W, Lin F, et al. The nursing care of regional citrate anticoagulation in patients treated with extracorporeal membrane oxygenation combined with continuous renal replacement therapy[J]. Chin J Emerg Crit Care Nurs, 2020, 1(3):238-240.
[24]	Giani M, Scaravilli V, Stefanini F, et al. Continuous renal replacement therapy in venovenous extracorporeal membrane oxygenation:a retrospective study on regional citrate anticoagulation[J]. ASAIO J Am Soc Artif Intern Organs, 2020, 66(3):332-338.
[25]	Chuang CL, Yang WC. Connecting continuous renal replacement therapy in parallel with extracorporeal membrane oxygenation:is there no problem?[J]. Kidney Int, 2010, 77(9):830.
[26]	Simons AP, Weerwind PW. Re:how to perform a haemodialysis using the arterial and venous lines of an extracorporeal life support[J]. Eur J Cardiothorac Surg, 2011, 39(6):1084-1085. DOI URL
[27]	曾妃, 梁江淑渊, 金小娟, 等. 6例特重度烧伤患者使用体外膜肺氧合联合连续性肾脏替代治疗的护理[J]. 中华护理杂志, 2021, 56(3):364-367.
	Zeng F, Liang JSY, Jin XJ, et al. Nursing care of 6 patients with severe burn treated with extracorporeal membran pulmonary oxygenation and continuous renal replacement therapy[J]. Chin J Nurs, 2021, 56(3):364-367.
[28]	Laverdure F, Masson L, Tachon G, et al. Connection of a renal replacement therapy or plasmapheresis device to the ECMO circuit[J]. Asaio J, 2018, 64(1):122-125. DOI PMID
[29]	Zhang Z, Chen K, Ni H, et al. Incorporation of a hemofilter circuit into venoarterial extracorporeal membrane oxygenation:a novel approach to provide more oxygenation[J]. Intensive Care Med, 2015, 41(4):729-730. DOI URL
[30]	高永霞, 宋燕波, 张劲松, 等. 多功能体外膜肺氧合循环管道的设计与应用[J]. 中华现代护理杂志, 2017, 23(8):1157-1158.
	Gao YX, Song YB, Zhang JS, et al. Design and application of multifunctional extracorporeal membrane oxygenation(ECMO) circulation tube[J]. Chin J Mod Nurs, 2017, 23(8):1157-1158.
[31]	de Tymowski C, Desmard M, Lortat-Jacob B, et al. Impact of connecting continuous renal replacement therapy to the extracorporeal membrane oxygenation circuit[J]. Anaesth Crit Care Pain Med, 2018, 37(6):557-564. DOI URL
[32]	缪惠洁, 张育才. 体外膜肺氧合下连续性肾替代治疗的难点和对策[J]. 中国小儿急救医学, 2018, 25(5):321-325.
	Miao HJ, Zhang YC. The method and challenge of combining extracorporeal membrane oxygenation and continuous renal replacement therapy[J]. Chin Pediatr Emerg Med, 2017, 25(5):321-325.
[33]	Van Kiersbilck C, Gordon E, Morris D. Ten things that nurses should know about ECMO[J]. Intensive Care Med, 2016, 42(5):753-755. DOI PMID
[34]	周益平, 史婧奕, 王斐, 等. 连续性肾替代治疗联合体外膜肺氧合救治儿童心肺衰竭的疗效观察[J]. 中华儿科杂志, 2018, 56(5):336-341.
	Zhou YP, Shi JY, Wang F, et al. Continuous renal replacement therapy combined with extracorporeal membrane oxygenation for pediatric cardiopulmonary failure[J]. Chin J Pediatr, 2018, 56(5):336-341.