体外膜肺氧合支持期间新发感染的研究进展

doi:10.3877/cma.j.issn.2096-1537.2024.03.014

近年来，体外膜肺氧合（ECMO）在急性可逆性心脏和（或）呼吸衰竭患者中应用越来越广泛。尽管ECMO的疗效已被证实，但它也有很多并发症，感染是ECMO期间常见并发症之一。ECMO期间感染可能影响ECMO患者的病死率。本文结合相关研究对ECMO支持期间新发感染进行综述以更深入地了解、预防和减少感染并发症。

关键词: 体外膜肺氧合, 体外生命支持, 感染, 并发症

In recent years, extracorporeal membrane oxygenation (ECMO) is being widely used to treat patients with acute reversibility refractory cardiogenic shock and/or refractory respiratory failure. Despite its proven efficacy, ECMO carries significant risks for complications, and infection is one of the most common complications during ECMO support. Infections during ECMO support have significantly increased mortality of these patients. In this paper, infections during ECMO support have been reviewed for a better understanding, prevention and management.

Key words: Extracorporeal membrane oxygenation, Extracorporeal life support, Infection, Complications

表1 单中心研究中ECMO支持期间感染参考定义和时间窗

文献作者及发表年份	定义	时间窗
Hsu等^[6]，2009	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Burket等^[7]，1999	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Schmidt等^[8]，2012	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Ayyıldız等^[9]，2017	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动后24 h至ECMO撤机后48 h
Calderón等^[10]，2018	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动至ECMO撤离
Aubron等^[11]，2013	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动后48 h至ECMO撤机后72 h
Sun等^[12]，2010	美国疾病控制和预防中心感控指南	ECMO启动至ECMO撤离
Kim等^[13]，2017	美国疾病控制和预防中心感控指南	ECMO启动后48 h至ECMO撤机后24 h

表1 单中心研究中ECMO支持期间感染参考定义和时间窗

文献作者及发表年份	定义	时间窗
Hsu等^[6]，2009	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Burket等^[7]，1999	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Schmidt等^[8]，2012	美国疾病控制和预防中心感控指南	ECMO启动后24 h至ECMO撤机后48 h
Ayyıldız等^[9]，2017	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动后24 h至ECMO撤机后48 h
Calderón等^[10]，2018	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动至ECMO撤离
Aubron等^[11]，2013	急症处置机构医疗保健相关感染的监测定义和特定类型感染的诊断标准	ECMO启动后48 h至ECMO撤机后72 h
Sun等^[12]，2010	美国疾病控制和预防中心感控指南	ECMO启动至ECMO撤离
Kim等^[13]，2017	美国疾病控制和预防中心感控指南	ECMO启动后48 h至ECMO撤机后24 h

表2 单中心研究ECMO支持期间感染发生率统计

文献作者	研究群体	感染[例（%）]
Hsu等^[6]	114例成人	10（8.8）
Burket等^[7]	71例患者（年龄≥17岁）	32（45.1）
Schmidt等^[8]	220例成人	142（64.5）
Ayyıldız等^[9]	25例新生儿，37例婴儿，3例儿童，1例成人	28（42.4）
Calderón等^[10]	50例年龄0~16岁患者	20（40.0）
Aubron等^[11]	139例患者（年龄≥17岁）	36（25.9）
Sun等^[12]	334例患者（年龄≥16岁）	45（13.5）
Kim等^[13]	61例患者（年龄≥17岁）	14（23.0）
Cashen等^[21]	247例新生儿，114例婴儿，77例儿童，43例成人	80（16.6）
Tse-Chang等^[22]	117例儿童（包括新生儿）	35（29.9）
Castagnola等^[23]	45例患者（年龄1 d~31岁）	12（26.6）
Quintana等^[24]	288例成人	58（20.1）

表2 单中心研究ECMO支持期间感染发生率统计

文献作者	研究群体	感染[例（%）]
Hsu等^[6]	114例成人	10（8.8）
Burket等^[7]	71例患者（年龄≥17岁）	32（45.1）
Schmidt等^[8]	220例成人	142（64.5）
Ayyıldız等^[9]	25例新生儿，37例婴儿，3例儿童，1例成人	28（42.4）
Calderón等^[10]	50例年龄0~16岁患者	20（40.0）
Aubron等^[11]	139例患者（年龄≥17岁）	36（25.9）
Sun等^[12]	334例患者（年龄≥16岁）	45（13.5）
Kim等^[13]	61例患者（年龄≥17岁）	14（23.0）
Cashen等^[21]	247例新生儿，114例婴儿，77例儿童，43例成人	80（16.6）
Tse-Chang等^[22]	117例儿童（包括新生儿）	35（29.9）
Castagnola等^[23]	45例患者（年龄1 d~31岁）	12（26.6）
Quintana等^[24]	288例成人	58（20.1）

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Research progress in hospital acquired infections of ECMO patients

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Research progress in hospital acquired infections of ECMO patients