Chen Yung-Chang, Tsai Feng-Chun, Fang Ji-Tseng, Yang Chih-Wei
Kidney Research Center, Department of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan; Chang Gung University College of Medicine, Taipei, Taiwan.
Chang Gung University College of Medicine, Taipei, Taiwan; Division of Cardiovascular Surgery, Chang Gung Memorial Hospital, Taipei, Taiwan.
J Formos Med Assoc. 2014 Nov;113(11):778-85. doi: 10.1016/j.jfma.2014.04.006. Epub 2014 Jun 10.
Extracorporeal membrane oxygenation (ECMO) has been utilized for critically ill patients such as patients with postcardiotomy cardiogenic shock or life-threatening respiratory failure. Acute kidney injury (AKI) that develops during ECMO is associated with a very poor outcome, possibly because of accumulated extravascular water causing interstitial overload, impaired oxygen transport through tissues, and increased extravascular lung water volume with impaired O(2) transport. Increased water is associated with subsequent organ dysfunction, particularly of the heart, lungs, and brain. Based on single-center studies, the incidence of AKI is 70-85% in ECMO patients. Therefore, renal replacement therapy is required in approximately 50% of these patients. This review summarizes three modalities that can be used to introduce renal replacement therapy to patients on ECMO, the pathophysiology of AKI in ECMO, and the impact of AKI on mortality. This review also identifies specific research-focused questions that need to be addressed to predict AKI early and to improve outcomes in this at-risk adult population.
体外膜肺氧合（ECMO）已用于重症患者，如心脏手术后心源性休克患者或危及生命的呼吸衰竭患者。ECMO期间发生的急性肾损伤（AKI）与非常差的预后相关，这可能是由于血管外水分积聚导致间质负荷过重、通过组织的氧运输受损以及血管外肺水容量增加伴氧运输受损。水分增加与随后的器官功能障碍相关，尤其是心脏、肺和脑。基于单中心研究，ECMO患者中AKI的发生率为70%-85%。因此，这些患者中约50%需要肾脏替代治疗。本综述总结了三种可用于对接受ECMO治疗的患者进行肾脏替代治疗的方式、ECMO中AKI的病理生理学以及AKI对死亡率的影响。本综述还确定了一些特定的以研究为重点的问题，这些问题需要得到解决，以便早期预测AKI并改善这一高危成年人群的预后。
