中国大陆地区儿童重症监护病房体外膜肺氧合应用现状的多中心调查  

Multicenter investigation of extracorporeal membrane oxygenation application in pediatric intensive care unit in China

作　　者：闫钢风 蔡小狄 周成斌[2] 洪小杨 王莹[4] 张晨美[5] 杨子浩[5] 张育才[6] 崔云[6] 崔彦芹 成怡冰 钱素云[9] 张鹏飞[9] 靳有鹏[10] 朱晓东 高宏 李自普 卢秀兰[14] 缪红军[15] 张秋月[16] 李玉梅[17] 杨卫国[18] 刘纯义[19] 李博 李英[21] 柏振江[21] 楚建平[22] 王旭 陆国平 Yah Gangfeng;Cai Xiaodi;Zhou Chengbin;Hong Xiaoyang;Wang Ying;Zhang Chenmei;Yang Zihao;Zhang Yucai;Cui Yun;Cui Yanqin;Cheng Yibing;Qian Suyun;Zhang Pengfei;Jin Youpeng;Zhu Xiaodong;Gao Hong;Li Zipu;Lu Xiulan;Miao Hongjun;Zhang Qiuyue;Li Yumei;Yang Weiguo;Liu Chunyi;Li Bo;Li Ying;Bo Zhenjiang;Chu Jianping;Wang Xu;Lu Guoping(Department of Pediatric Emergency Medicine,Children's Hospital of Fudan University,Shanghai 201102,China)

机构地区：[1]复旦大学附属儿科医院重症医学科,上海201102 [10]山东省立医院儿童重症监护室 [11]上海交通大学附属新华医院儿童重症医学科 [12]陕西省西北妇女儿童医院心脏中心 [13]青岛市妇女儿童医院重症医学中心 [14]湖南省儿童医院重症医学科 [15]南京医科大学附属儿童医院重症医学科 [16]黑龙江省哈尔滨医科大学附属第一医院儿科重症监护病房 [17]吉林省吉林大学第一医院儿科重症监护病房 [18]广东省深圳市儿童医院儿科重症监护病房 [19]广东省深圳市宝安区妇幼保健院儿科重症监护病房 [2]广东省人民医院心外科 [20]山东省枣庄市妇幼保健院重症医学科 [21]苏州大学附属苏州儿童医院儿科重症监护病房 [22]西安市儿童医院重症医学科 [23]中国医学科学院阜外医院小儿科中心 [3]陆军总医院附属八一儿童医院重症医学科 [4]上海交通大学医学院附属上海儿童医学中心重症医学科 [5]浙江大学医学院附属儿童医院重症医学科 [6]上海交通大学附属上海市儿童医院重症医学科 [7]广东省广州市妇女儿童医疗中心 [8]郑州儿童医院重症监护室 [9]首都医科大学附属北京儿童医院重症医学科

出　　处：《中华儿科杂志》2018年第12期929-932,共4页Chinese Journal of Pediatrics

摘　　要：目的了解中国大陆地区儿童重症监护病房(PICU)体外膜肺氧合(ECM0)临床应用的现状和治疗效果。方法采用问卷横断面调查方法描述中国大陆地区开展ECMO治疗的儿童专科医院或综合医院的PICU应用ECMO情况;分析接受ECMO治疗患儿的疾病种类及治疗效果。结果截至2017年12月31日,国内开展儿童ECMO技术的医院共23家,三级医院22家,二级医院1家;专科儿童医院16家,综合性医院7家。共有ECMO设备37台。共518例患儿接受ECMO治疗,成功撤离ECMO病例323例(62.4%),存活出院病例262例(50.6%)。非新生儿组375例,成功撤离ECMO 233例(62.1%),存活出院186例(49.6%)。新生儿组143例,成功撤离ECMO者90例(62.9%),存活出院76例(53.1%)。518例患儿中,静脉。动脉(VA)模式501例(96.7%),静脉一静脉(VV)模式14例(2.7%),VV转VA 3例(0.6%)。体外心肺复苏(ECPR)患儿共69例,新生儿组20例(29.0%),非新生儿组49例(71.0%);均因心脏疾病接受ECPR。新生儿组中呼吸系统疾病以新生儿呼吸窘迫综合征最多(26/61),其次为新生儿持续肺动脉高压(12/61)和胎粪吸入综合征(11/61)。存活率最高的疾病为新生儿持续肺动脉高压(10/12)和胎粪吸入综合征(9/11)。新生儿循环系统疾病中,先天性心脏病术后最多(54/82),存活率最高的是脓毒症休克(2/3)。非新生儿组中,呼吸系统疾病中,急性呼吸窘迫综合征最多(42/93),存活率较高的为塑形支气管炎(4/4)、病毒性肺炎(13/16)。循环系统疾病中,先天性心脏病患儿最多(124/282);存活率最高的是暴发性心肌炎(54/77)。结论ECMO技术在中国大陆地区PICU内严重心肺功能衰竭患儿中迅速发展,对抢救儿科危重症具有重要的实用价值。Objective To survey the conduction and evaluate the effectiveness of extracorporeal membrane oxygenation (ECMO)therapy in pediatric intensive care unit (PICU)in China mainland. Methods In a questionnaire-based survey,we retrospectively reviewed the application of ECMO in children's hospital and general hospital in China mainland to summarize and analyze the categories of diseases and prognosis of children treated with ECMO therapy.Results By December 31,2017,a total of 23hospitals using ECMO,including 22tertiary refenal hospitals and 1secondary hospital,among which 16 were children's hospitals and 7were general hospitals.Thirty-seven ECMO equipment was available.A total of 518patients treated with ECMO,within whom 323(62.4%)successfully weaned from ECMO and 262 (50.6%)survived to discharge.Among 375pediatric patients,233(62.1%)were successfully weaned from ECMO and 186(49.6%)survived to discharge.Among 143newborn patients,90(62.9%)successfully weaned from ECMO,76(53.1%)survived to discharge.ECMO was applied in veno-arterial (VA)mode to 501(96.7%)patients,veno-venous (VV)mode to 14(2.7%)patients,and VV-VA conversion mode to 3 (0.6%)patients.Sixty-nine patients required extraeorporeal eardiopulmonary resuscitation (ECPR), including 20newborn patients (29.0%)and 38pediatric patients (71.0%),who were all with cardiovascular disease.Neonatal respiratory distress syndrome (26/61),persistent pulmonary hypertension of the newborn (PPHN)(12/61),and meeonium aspiration syndrome (MAS)(11/61)are the most common pulmonary diseases in newborn patients;among whom,infants with PPHN had highest survival rate (10/12),followed by MAS (9/11).Among newborn patients with cardiovascular diseases,those who admitted were after surgery for congenital cardiac disease were the most common (54/82),while those with septic shock had the highest survival rate (2/3).In pediatric pulmonary diseases,acute respiratory distress syndrome was the most common (42/93),while plastic bronchitis was with the highest survival rate (4/4),followed by viral pn

关 键 词：重症监护病房 儿科 问卷调查 体外膜氧合作用 

分 类 号：R720.597[医药卫生—急诊医学]