摘要目的:探讨体外膜肺氧合（ECMO）在危重症孕产妇急救中应用的安全性及有效性。方法:回顾性分析2017年9月至2020年11月在南京大学医学院附属鼓楼医院重症医学科因严重心肺功能障碍应用ECMO救治的8例围生期孕产妇的治疗过程。结果:8例孕产妇年龄（32.5±6.3）岁，体质量（73.5±8.1）kg，孕周（31.0±4.4）周，急性生理学与慢性健康状况评分Ⅱ（APACHEⅡ）为（13.0±6.6）分，序贯器官衰竭评分（SOFA）为（8.3±3.8）分。5例合并重症肺炎的孕产妇行静脉-静脉ECMO（VV-ECMO）治疗；3例心力衰竭（心衰）孕产妇实施静脉-动脉ECMO（VA-ECMO）。8例孕产妇ECMO治疗初始流速设定为2.0~3.0 L/min，最高流速为（3.1±0.6）L/min，ECMO运行时间为（174±36）h，重症监护病房（ICU）住院时间为（16.0±5.4）d。5例重症肺炎、1例围生期心肌病孕产妇成功撤离ECMO痊愈出院，2例肺动脉高压孕产妇预后不良。7例孕产妇的婴儿存活，其中2例为撤离ECMO后娩出，1例则在ECMO保障下行急诊剖宫术；另外1例孕产妇因未足孕周，胎儿未能娩出。8例孕产妇ECMO运行期间虽无严重出血并发症，但1例合并肝素诱导血小板减少症并血栓形成（HITT），更换抗凝治疗后好转；1例孕产妇穿刺血管内有血栓形成，序贯抗凝治疗3个月。结论:ECMO在危重症孕产妇的抢救中起到了积极的作用，针对可逆性的严重心肺功能不全孕产妇，需及早评估ECMO的应用指征，提高母婴存活率。

abstractsObjective:To investigate the safety and effectiveness of extracorporeal membrane oxygenation (ECMO) in emergency treatment of critically ill pregnant women.Methods:Clinical data of 8 pregnant women with severe cardiopulmonary dysfunction during the perinatal period treated by ECMO in the department of intensive care unit (ICU) of Nanjing Drum Tower Hospital, the Affiliated Hospital to Nanjing University Medical School from September 2017 to November 2020 were retrospectively analyzed. Results:For the 8 pregnant women, the mean age was (32.5±6.3) years old. Body weight was (73.5±8.1) kg. Gestational age was (31.0±4.4) weeks. Acute physiology and chronic health evaluationⅡ (APACHEⅡ) score was 13.0±6.6, and sequential organ failure assessment (SOFA) score was 8.3±3.8. Among them, 5 pregnant women suffered from severe pneumonia and were treated with veno-venous ECMO (VV-ECMO). Another 3 pregnant women with heart failure underwent veno-arterial ECMO (VA-ECMO). The initial ECMO flow rate was set to 2.0-3.0 L/min. Then the highest flow rate was (3.1±0.6) L/min, and the average ECMO running time was (174±36) hours. The length of ICU stay was (16.0±5.4) days. Six pregnant women (5 with severe pneumonia and 1 with peripartum cardiomyopathy) successfully evacuated from ECMO and survived. Two pregnant women with pulmonary hypertension showed poor prognosis. In total, seven babies survived. Two of them were delivered after ECMO evacution, and one underwent emergency cesarean section with ECMO support. In another case, the fetus could not be delivered due to under-gestational weeks. During this period, there were no serious bleeding complications. One pregnant woman developed heparin-induced thrombocytopenia and thrombosis (HITT), then she received another anticoagulant treatment. One pregnant woman got sequential anticoagulation therapy for 3 months on account of thrombosis in the puncture vessel.Conclusions:ECMO has played an active role in the rescue of critically ill pregnant women. For those with reversible severe cardiopulmonary dysfunction, it is necessary to evaluate the application of ECMO as early as possible to improve the survival rate of mothers and infants.