体外膜肺氧合联合连续性肾脏替代治疗救治危重症新生儿四例  

Extracorporeal membrane oxygenation combined with continuous renal replacement therapy in the treatment of critically ill newborns:a report of 4 cases

作　　者：洪文超 裘刚[1] 龚小慧[1] 蔡成[1] 陈豪 颜崇兵[1] 马俐 Hong Wenchao;Qiu Gang;Gong Xiaohui;Cai Cheng;Chen Hao;Yan Chongbing;Ma Li(Department of Neonatology,Shanghai Children’s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院新生儿科,200062

出　　处：《中华新生儿科杂志（中英文）》2020年第4期251-255,共5页Chinese Journal of Neonatology

摘　　要：目的探讨体外膜肺氧合(extra corporeal membrane oxygenation,ECMO)联合连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)救治危重症新生儿的临床效果。方法回顾性分析2016年11月至2018年12月上海市儿童医院新生儿重症监护病房接受ECMO联合CRRT救治的危重新生儿。总结患儿原发疾病、ECMO治疗的主要原因、治疗日龄、出生体重、联合治疗持续时间、并发症及临床转归等,比较ECMO联合CRRT治疗前后患儿白细胞、血小板、血肌酐、尿素氮、尿量、血气分析等变化情况,采用t检验对数据进行统计学分析。结果共纳入4例危重症新生儿,原发病为新生儿胎粪吸入综合征1例,肺动脉高压3例。ECMO模式为动脉-静脉ECMO,CRRT模式为连续性静脉-静脉血液滤过透析,ECMO上机日龄(68.0±70.7)h,上机前氧合指数51.8±17.5,ECMO持续运转时间(135.0±73.0)h,CRRT持续运转时间(90.5±56.2)h。治疗1 d后与治疗前相比尿量显著增多[(4.30±1.66)ml/(kg·h)比(1.24±0.50)ml/(kg·h)],差异有统计学意义(P<0.05);治疗前后白细胞、血小板、肌酐、谷丙转氨酶、乳酸等比较,差异无统计学意义(P>0.05)。治疗中发生颅内出血、溶血和伤口出血各1例。2例存活,2例死亡。结论危重症新生儿出现急性肾损伤和液体超载时应用ECMO联合CRRT治疗能取得较好效果。Objective To study the efficacy of extracorporeal membrane oxygenation(ECMO)combined with continuous renal replacement therapy(CRRT)in the treatment of critically ill newborns.Method The critical newborns treated by ECMO combined with CRRT in neonatal intensive care unit of the Shanghai Children's Hospital from November 2016 to December 2018 were studied retrospectively.The primary disease,the main cause of ECMO treatment,treatment age,birth weight,duration of combination therapy,complications,clinical outcomes of the 4 neonates were collected and studied.The changes of leukocytes,platelets,serum creatinine,blood urea nitrogen,output and blood gas analysis were compared before and after ECMO combined with CRRT.T-test was used to analyze the data.Result A total of 4 critically ill newborns were included,including 1 case of neonatal meconium aspiration syndrome and 3 cases of pulmonary hypertension.ECMO mode was arterial-venous ECMO and CRRT mode was continuous venous-venous hemofiltration dialysis.The statistical results were as follows:gestational age(38.8±1.6)weeks,birth weight(3643±346)g,age of admission(9.8±6.6)h,ECMO on board age(68.0±70.7)h,oxygen index before ECMO 51.8±17.5,ECMO treatment time(135.0±73.0)h,CRRT time(90.5±56.2)h.One day after treatment,the fluid output was significantly increased compared with that before treatment[(4.30±1.66)ml/(kg·h)vs.(1.24±0.50)ml/(kg·h)](P<0.05).There was no significant difference in leukocytes,platelets,creatinine,glutamic pyruvic transaminase and lactic acid before and after treatment(P>0.05).During the treatment,there were 1 case of intracranial hemorrhage,1 case of hemolysis and 1 case of wound hemorrhage.2 cases survived and 2 demised.Conclusion ECMO combined with CRRT can achieve better results in the treatment of acute renal injury and fluid overload in critically ill newborns.

关 键 词：体外膜肺氧合 急性肾损伤 连续性肾脏替代治疗 婴儿 新生 

分 类 号：R720.597[医药卫生—急诊医学]