体外膜氧合患者脑监测中国专家共识
Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation
摘要近年来,随着体外膜氧合在严重呼吸衰竭、心源性休克和心肺复苏患者中的使用显著增加,体外膜氧合相关并发症越来越受重视,而脑损伤是体外膜氧合治疗期间最严重并发症之一,是影响体外膜氧合患者住院死亡率及远期生存质量的重要因素。由于镇痛、镇静及肌松药的应用干扰神经系统体格检查结果,使得体外膜氧合治疗期间发生的脑损伤不容易被及时发现。因此床旁脑监测对于发现体外膜氧合患者脑损伤并提供早期干预指导具有重要价值。由此,中国医师协会体外生命支持专业委员会组织全国相关专家制订了《体外膜氧合患者脑监测中国专家共识》,本共识以体外膜氧合患者脑损伤的病理生理学机制为基础,以神经系统体格检查、血浆脑损伤生物标记物、颅脑影像、颅内压、脑血流、脑氧、脑电图、体感诱发电位等脑监测技术应用现状为依据,结合体外膜氧合的特殊临床应用场景,整合国内外最新循证医学证据,形成可供重症医学、神经病学、心血管病学、呼吸与危重病学、急诊医学等专业人员参考的15条体外膜氧合患者脑监测专家共识推荐意见。鉴于重症患者的特殊性、复杂性及个体差异,本专家共识推荐意见需结合患者个体情况而定。
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abstractsWith the significant increase in the use of extracorporeal membrane oxygenation in patients with severe respiratory failure, cardiogenic shock, and cardiopulmonary resuscitation, complications related to extracorporeal membrane oxygenation are increasingly being taken seriously. Cerebral injury is one of the most serious complications during extracorporeal membrane oxygenation treatment, and is an important factor affecting the hospital mortality rate and long-term quality of life. Due to the use of analgesics, sedatives, and muscle relaxants interfering with neurological physical examination results, cerebral injury that occurs during extracorporeal membrane oxygenation therapy is not easily detected in a timely manner. Therefore, bedside cerebral monitoring has important value in quickly detecting cerebral injury in patients with extracorporeal membrane oxygenation and providing early intervention guidance. Therefore, Extracorporeal Life Support Professional Committee of Chinese Medical Doctor Association organized relevant experts across the country to develop the"Chinese expert consensus on cerebral monitoring in patients with extracorporeal membrane oxygenation", this expert consensus is based on the pathological and physiological mechanisms of cerebral injury in patients with extracorporeal membrane oxygenation. It is based on the current application status of cerebral monitoring technologies such as neurological physical examination, plasma brain injury biomarkers, brain imaging, intracranial pressure, cerebral blood flow, brain oxygen, electroencephalogram, and somatosensory evoked potential. Combining the special clinical application scenarios of extracorporeal membrane oxygenation and integrating the latest evidence-based medical evidence, we have formed 15 consensus recommendations which can be referenced by professionals in critical care medicine, neurology, cardiovascular disease, respiratory and critical care, emergency medicine, and other fields. Given the particularity, complexity, and individual differences of critically ill patients, the recommendations formed by this expert consensus need to implement personalized strategies.
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