體外膜氧合治療的臨床使用

Clinical Application of Extracorporeal Membrane Oxygenation

邊苗瑛(Mauo-Ying Bien) ； 龍芳(Fang Jung) ； 林佑穗(You-Shuei Lin) ； 楊式興(Shih-Shing Yang)

《呼吸治療》 9卷1期 (2010/01) Pp. 41-52

https://doi.org/10.6269/JRT.2010.9.1.05

摘要

體外膜氧合(extracorporeal membrane oxygenation, ECMO)，又稱“葉克膜體外維生系統”，是將體內靜脈血引出體外，流經特殊材質的氧合器靠擴散作用進行氣體交換後，再經人工幫浦將血液注入病人的動脈或靜脈系統，替代部份心肺作用，維持人體組織氧合血的供應。ECMO是由專爲開心手術所建立的體外循環系統改進而來，爲密閉性管路，操作上較爲簡便而快速，裝置時多數無需開胸手術，無需大量的抗凝血藥物使用，減少了出血及血栓等併發症的發生，讓ECMO可廣泛應用於臨床急救及延長時間的生命支持，可提供受損器官較充裕的恢復時間與治療空間，提高治癒率。隨著醫學的進步與技術的成熟，許多因使用ECMO所引發的併發症也得以克服，使用的範圍從心臟衰竭擴及重症昏迷的急難傷患與嚴重的呼吸衰竭病患。一般依病患病情的需要，可分为靜脈至動脈(venous-arterial, VA)或靜脈至靜脈(venous-venous, VV)ECMO兩大類。如能慎選病患，及早使用以避免續發性器官受損，將有助於提升存活率；而ECMO使用中適當的病患照護，尤其是急性呼吸窘迫症候群病患呼吸器的適當設定與調整，將有助於病患的恢復及避免肺損傷；但ECMO的使用費用甚高，如何審慎使用是醫療資源合理分配的重要課題。

關鍵字

體外膜氧合 ； 體外維生系統 ； 心肺體外循環 ； 靜脈至動脈體外膜氧合 ； 靜脈至靜脈體外膜氧合

並列摘要

Extracorporeal membrane oxygenation (ECMO) is a technique for providing life support to patients with severe cardiac and/or pulmonary problems. This was an adaption of conventional cardiopulmonary bypass techniques which require the diversion of blood from a major systemic vessel through a gas exchange device (membrane oxygenator) and back to a major blood vessel. Because the ECMO is a closed system without blood reservoir, it does not require much anticoagulant to prevent embolus formation in the patient. Two types of ECMO are clinically used. The venoarterial (VA) approach has served as the primary mode of cannulation for both cardiac and respiratory failure since the advent of extracorporeal support. Utilizing a central vein for drainage and an artery for return, VA cannulation thus provides direct cardiovascular support. Alternatively, venovenous (VV) cannulation provides a means of extracorporeal support for patients with severe respiratory failure who do not require cardiac support. Utilizing a major vein for blood drainage and a vein for the return of oxygenated blood to the heart, the VV approach, while not directly providing circulatory support, replaces the pulmonary gas exchange and theoretically offers indirect cardiac support without ligation of a major artery. ECMO is currently in wide use by patients with critically traumatic conditions, cardiac failure, or severe respiratory failure. Early application of ECMO may offer survival benefit to carefully selected patients. Appropriate ventilator settings and adjustments during ECMO therapy are crucial in order to avoid ventilator-induced lung injury. Because ECMO therapy is costly, the decisions to apply or not apply the modality and the timing to remove it are important issues to consider regarding the allocation of limited medical resource.

並列關鍵字

Extracorporeal membrane oxygenation ECMO ； Extracorporeal life support ECLS ； Veno-arterial ECMO VA-ECMO ； Veno-venous ECMO VV-ECMO