静脉-动脉体外膜肺氧合在儿童先天性心脏病治疗中的应用  

Efficacy of venoarterial extracorporeal membrane oxygenation in pediatric patients undergoing repair of congenital heart disease

作　　者：钟慧[1] 何春兰[1] 王秀华[1] 诸冰雪[1] 叶明[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032

出　　处：《中国体外循环杂志》2010年第3期179-182,共4页Chinese Journal of Extracorporeal Circulation

基　　金：上海市重点学科建设项目(B116)

摘　　要：目的探讨静脉-动脉体外膜肺氧合(ECMO)在儿童复杂先天性心脏病手术治疗中的应用效果。方法自2008年12月至2009年12月对4例患儿行体外膜肺氧合支持治疗,年龄2～21(8.25±8.66)个月,体重4.5～9(5.87±2.09)kg。诊断包括左冠状动脉起源于肺动脉1例,完全性大动脉错位2例和完全性肺静脉异位引流1例。适应证为患者心内畸形纠治术后不能脱离体外循环和/或并发肺动脉高压危象。结果平均ECMO支持时间为14～171(50.95±80.15)h。4例全部撤离ECMO并顺利出院。其中1例患儿术后3个月因循环衰竭死亡,其余患儿术后随访6～14(10.50±4.12)个月病情稳定。结论婴幼儿复杂先天性心脏病术后不能脱离体外循环的患者行ECMO支持能降低其死亡率。OBJECTIVE To report our experience with venoarterial extracorporeal membrane oxygenation（ECMO） in a congenital heart surgery program at Children＇s Hospital of Fudan University.METHODS Since 12/2008,4 patients（3 infants,1 children）,mean age 2-21（8.25±8.66） months,body weight 4.5～9（5.87±2.09） kg used ECMO as circulatory support.Diagnoses included anomalous origin of the left coronary artery from the pulmonary artery（1）,transposition of the great arteries（2）,and total anomalous pulmonary venous drainage（1）.Indication was failure to wean from cardiopulmonary bypass in the majority of cases and one reason was pulmonary hypertension.RESULTS Mean duration of support was 14 h-171（50.95±80.15） hours.Overall four patients were weaned from ECMO and were discharged.They are clinically well after 6-14（10.50±4.12） months,except One patients was sudden death at home after 3 months later.CONCLUSION In our group,the availability of ECMO for infants failing to wean from extracorporeal circulation was associated with reduced mortality,especially in children undergoing repair of the most complex congenital heart malformations.

关 键 词：体外膜肺氧合 先天性心脏病 儿童 

分 类 号：R726.5[医药卫生—儿科]