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中华重症医学电子杂志 doi: 10.3877/cma.j.issn.2096-1537.2025.01.0004

指南解读

《成人体外膜肺氧合技术操作规范(2024年版)》解读:抗凝与出血并发症防治
屠国伟1, 李敏2, 罗哲1,()   
  1. 1.200032 上海,复旦大学附属中山医院心脏重症监护中心
    2.100029 北京,中日友好医院呼吸与危重症医学科
  • 收稿日期:2024-12-29
  • 通信作者: 罗哲

Interpretation of adult extracorporeal membrane oxygenation technical operation standards: anticoagulation and prevention and treatment of bleeding complications

Guowei Tu1, Min Li2, Zhe Luo1,()   

  1. 1.Cardiac Intensive Care Unit, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200032, China
    2.Department of Respiratory and Critical Care Medicine, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2024-12-29
  • Corresponding author: Zhe Luo
引用本文:

屠国伟, 李敏, 罗哲. 《成人体外膜肺氧合技术操作规范(2024年版)》解读:抗凝与出血并发症防治[J/OL]. 中华重症医学电子杂志, doi: 10.3877/cma.j.issn.2096-1537.2025.01.0004.

Guowei Tu, Min Li, Zhe Luo. Interpretation of adult extracorporeal membrane oxygenation technical operation standards: anticoagulation and prevention and treatment of bleeding complications[J/OL]. Chinese Journal of Critical Care & Intensive Care Medicine(Electronic Edition), doi: 10.3877/cma.j.issn.2096-1537.2025.01.0004.

血栓形成和出血是体外膜肺氧合(ECMO)患者常见的管理问题。如何平衡血栓形成和出血风险依然面临挑战。为指导ECMO抗凝实践,笔者基于《成人体外膜肺氧合技术操作规范(2024年版)》,详细解读了ECMO抗凝管理的规范。本文详细介绍了ECMO管理中常用的抗凝剂,包括其作用机制、监测方法、优点和局限性,并阐述了现有的抗凝剂监测指标、抗凝目标及各种监测方法的优缺点。

Thrombosis and bleeding are prevalent complications in patients undergoing extracorporeal membrane oxygenation (ECMO) therapy. Striking the right balance between the risks of thrombosis and bleeding remains a significant challenge. To guide the practice of ECMO anticoagulation, we have focused on interpreting the norms of ECMO anticoagulation management based on the “Guidelines for Adult ECMO Technical Operations”. This review elucidates these guidelines, detailing the anticoagulants frequently employed in ECMO management, encompassing their mechanisms of action, monitoring techniques,benefits, and drawbacks. Additionally, it outlines the current indices for anticoagulant monitoring, objectives for anticoagulation therapy, and the merits and demerits of various monitoring approaches.

表1 ECMO 常用抗凝剂的作用机制、半衰期和优缺点
表2 抗凝检测结果不一致时的处理
表3 不同抗凝监测指标的优缺点
表4 不同实验室指标下推荐的抗凝监测频率
1
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