中国血液净化

中国血液净化 ›› 2026, Vol. 25 ›› Issue (04): 300-304.doi: 10.3969/j.issn.1671-4091.2026.04.006

• 临床研究 • 上一篇    下一篇

肺移植术后患者体外膜肺氧合联合连续性肾脏替代治疗期间非计划性下机现状及影响因素分析

冯世萍   王海翔   钱秀群   黄 浩   

  1. 214023 无锡，1南京医科大学无锡医学中心/无锡市人民医院/南京医科大学附属无锡人民医院重症医学科
  • 收稿日期:2025-07-25 修回日期:2026-01-18 出版日期:2026-04-12 发布日期:2026-04-12
  • 通讯作者: 王海翔 E-mail:625821129@qq.com
  • 基金资助:
    无锡市卫生健康委青年科研项目(Q202323)；南京医科大学科技发展基金项目(NMUB20240252)

Analysis on the current status and influencing factors of unplanned disconnection during extracorporeal membrane oxygenation combined with continuous renal replacement therapy in patients after lung transplantation

FENG Shi-ping, WANG Hai-xiang, QIAN Xiu-qun, HUANG Hao   

  1. Department of Intensive Care Unit,The Affiliated Wuxi People's Hospital of Nanjing Medical University, Wuxi People's Hospital, Wuxi Medical Center, Nanjing Medical University, Jiangsu 214023, China
  • Received:2025-07-25 Revised:2026-01-18 Online:2026-04-12 Published:2026-04-12
  • Contact: 214023 无锡，1南京医科大学无锡医学中心/无锡市人民医院/南京医科大学附属无锡人民医院重症医学科 E-mail:625821129@qq.com

摘要： 目的 探讨肺移植术后患者体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)联合连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)期间，发生CRRT非计划性下机现状及影响分析。方法 回顾性分析2018年2月─2024年3月无锡市人民医院收治的67例肺移植术后患者行ECMO联合CRRT治疗的临床资料，根据CRRT非计划性下机指征，分为CRRT计划性下机组和CRRT非计划性下机组，采用单因素分析筛选潜在影响因素后，进一步通过多因素Logistic回归分析明确肺移植术后ECMO联合CRRT期间CRRT非计划性下机的独立影响因素。 结果 本研究最终纳入67例肺移植术后患者，共实施ECMO联合CRRT治疗211例次，治疗期间发生CRRT非计划性下机119例次，发生率为56.4%。多因素Logistic回归分析显示:ECMO模式(OR=0.089，95% CI：0.027～0.301，P＜0.001)、ECMO平均血流速度(OR=18.779，95% CI：6.754～52.211，P＜0.001)及CRRT平均超滤率(OR=1.024，95% CI：1.013～1.034，P＜0.001)均为肺移植术后患者在ECMO联合治疗期间发生CRRT非计划性下机的独立危险因素。  结论 在肺移植术后,患者接受ECMO联合CRRT治疗过程中，静脉-动脉体外膜肺氧合(veno-arterial extracorporeal membrane oxygenation，VA-ECMO)支持期间、ECMO高血流速度及CRRT过高超滤速度均是CRRT非计划性下机的独立风险因素，提示临床医务人员需通过制定精细化治疗方案、预见性处理设备报警及管路相关问题，以降低CRRT非计划性下机发生率，进而改善肺移植患者预后。

关键词: 肺移植, 体外膜肺氧合, 肾脏替代治疗, 非计划性下机, 影响因素

Abstract: Objective  To explore the current status and influencing factors of unplanned disconnection from continuous renal replacement therapy(CRRT) in patients after lung transplantation during treatment with extracorporeal membrane oxygenation(ECMO) combined with CRRT.  Methods  A retrospective analysis was conducted on the clinical data of 67 patients who underwent lung transplantation and received ECMO combined with CRRT treatment at Wuxi People’s Hospital from February 2018 to March 2024. Based on the criteria for unplanned CRRT disconnection, the patients were divided into the planned CRRT disconnection group and the unplanned CRRT disconnection group. After screening for potential influencing factors using univariate analysis, multivariate Logistic regression analysis was further performed to investigate the independent influencing factors of unplanned CRRT disconnection in post-lung transplant patients during ECMO combined with CRRT treatment. Results  A total of 67 post-lung transplant patients were included in this study, with a total of 211 episodes of ECMO combined with CRRT treatment. During the period, 119 episodes of unplanned CRRT disconnection occurred, with an incidence rate of 56.4%. Multivariate Logistic regression analysis showed that ECMO mode (OR=0.089, 95%CI:0.027～0.301, P＜0.001), average ECMO blood flow rate (OR=18.779, 95% CI:6.754～52.211, P＜0.001), and average CRRT ultrafiltration rate (OR=1.024, 95%CI:1.013～1.034, P＜0.001) were independent risk factors for unplanned CRRT disconnection in patients undergoing combined ECMO and CRRT therapy after lung transplantation. Conclusion During ECMO combined with CRRT therapy in patients after lung transplantation, veno-arterial ECMO (VA-ECMO) support, high ECMO blood flow rate, and excessively high CRRT ultrafiltration rate are all independent risk factors for unplanned CRRT disconnection. These findings suggest that clinical medical staff should develop refined treatment plans and proactively address equipment alarms and pipeline-related issues to reduce the incidence of unplanned CRRT disconnection, thereby improving the prognosis of patients after lung transplantation.

Key words: Lung transplantation, Extracorporeal membrane oxygenation, Renal replacement therapy, Unplanned disconnection; , Influencing factors

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