成人ARDS中俯卧位通气与ECMO联合应用的研究进展
Research Progress on the Combined Application of Prone Positioning Ventilation and ECMO in Adult ARDS
摘要: 急性呼吸窘迫综合征(ARDS)是危重症患者死亡的主要原因之一。俯卧位通气(PP)和静脉–静脉体外膜肺氧合(VV-ECMO)是重症ARDS治疗中的两项重要策略。PP通过改善通气–血流比、促进肺复张及减轻呼吸机相关性肺损伤(VILI)降低中重度ARDS患者死亡率；VV-ECMO则通过体外气体交换实现“肺休息”和超保护性通气，已成为重度ARDS的挽救性治疗。然而，对于已接受VV-ECMO支持的ARDS患者，联合应用PP是否能带来额外获益，目前仍存在争议。现有Meta分析提示联合治疗可改善短期生存率，但最新的随机对照试验(PRONECMO)未证实其对ECMO撤机成功率的优势。本文系统综述PP与ECMO联合应用在成人ARDS中的生理学基础、临床证据、争议焦点及未来研究方向，旨在为临床决策提供参考。
Abstract: Acute respiratory distress syndrome (ARDS) remains a leading cause of mortality among critically ill patients. Prone positioning (PP) and venovenous extracorporeal membrane oxygenation (VV-ECMO) represent two cornerstone strategies for managing severe ARDS. PP improves oxygenation and reduces mortality by enhancing ventilation-perfusion matching, facilitating the recruitment of collapsed alveoli, and mitigating ventilator-induced lung injury (VILI). Concurrently, VV-ECMO enables “lung rest” via ultra-protective mechanical ventilation through extracorporeal gas exchange, serving as a vital salvage therapy. However, the incremental benefit of incorporating PP in patients already undergoing VV-ECMO remains a subject of intense debate. While several meta-analyses suggest that this combined approach may improve short-term survival, the recent randomized controlled trial (PRONECMO) failed to demonstrate the superiority of PP over supine positioning regarding successful ECMO weaning. This article provides a comprehensive review of the physiological rationale, clinical evidence, points of contention, and future research directions for the combined use of PP and ECMO in adults with ARDS, aiming to offer an evidence-based reference for clinical decision-making.
文章引用：杨一帆, 郭海鹏. 成人ARDS中俯卧位通气与ECMO联合应用的研究进展[J]. 临床医学进展, 2026, 16(5): 2950-2958. https://doi.org/10.12677/acm.2026.1652108

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