颈部插管在重症患儿体外膜肺氧合治疗中的应用价值  

Application of cervical intubation for severe diseases by extracorporeal membrane oxygenation in children

作　　者：应力阳[1] 齐建川[1] 刘喜旺[1] 范勇[2] 叶莉芬[2] 林茹[2] 舒强[1] Ying Liyang;Qi Jianchuan;Liu Xiwang;Fan Yong;Ye Lifen;Lin Ru;Shu Qiang(Department of Cardiac Center,National Clinical Research Center for Child Health,Zhejiang University School of Medicine,Hangzhou 310052,China;Department of Extracorporeal Circulation&Life Supports,The Children's Hospital,Zhejiang University School of Medicine,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏外科国家儿童健康与疾病临床医学研究中心,浙江省杭州市310052 [2]浙江大学医学院附属儿童医院体外循环及生命支持科,浙江省杭州市310052

出　　处：《临床小儿外科杂志》2020年第10期926-929,共4页Journal of Clinical Pediatric Surgery

基　　金：浙江省医药卫生科技计划(编号:2015KYB193)。

摘　　要：目的总结及探讨右侧颈动脉、颈内静脉切开插管技术在小儿体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)中的应用价值。方法回顾性收集2009年11月至2019年2月在浙江大学医学院附属儿童医院经右侧颈部插管ECMO治疗的重症患儿作为研究对象,分析其疾病类型、年龄、体重、ECMO持续时间、并发症及转归等情况。结果本研究共纳入70例行右侧颈部插管ECMO治疗的重症患儿,其中男童39例,女童31例,均在充分镇静、镇痛、肌松及呼吸机支持下行右侧颈动脉和颈内静脉切开插管。3例插管失败,其余均插管成功,其中3例因静脉狭窄扩大切口远端插管,1例新生儿静脉撕裂扩大切口远端插管,1例迷走神经损伤导致声音嘶哑,2例插管顶端位置不佳予以调整插管,1例出现插管头端血栓予以更换插管,18例在心肺复苏(cardiopulmonary resuscitation,CPR)下插管。ECMO转机均采用V-A模式,插管手术时间(41.1±32.3)min,ECMO转机时间(167.5±133.5)h,中位运行时间120 h。51例成功撤机,撤机时行近心端动静脉结扎。结论右侧颈动脉、颈内静脉切开插管在小儿ECMO治疗中是安全有效的。Objective To summarize and discuss the application of right carotid artery and internal jugular vein cannulation in extracorporeal membrane oxygenation(ECMO)in children.Methods A total of 70 ECMO children were recruited from November 2009 to February 2019.And disease type,age,weight,ECMO time,complications and prognosis were analyzed.Results All children underwent ECMO via right cervical cannulation.There were 39 boys and 31 girls.All of them underwent right carotid artery and internal jugular vein incision and intubation under sufficient sedation,pain relief,muscle relaxation and ventilator supports.Three cases failed while the others succeeded in intubation.In 3 cases,distal intubation of incision was enlarged due to venous stenosis.One case of neonatal vein was torn and enlarged with distal vein intubation and another case of hoarseness occurred due to vagus nerve injury.Two cases of intubation were adjusted due to a poor position of intubation tip and one case with thrombus at the intubation head was replaced with new intubation.And 18 cases were intubated under cardiopulmonary resuscitation(CPR).V-A mode was employed for all ECMO children.The operative duration of intubation was(41.1±32.3)min,the time of ECMO running(167.5±133.5)hours and the median operative duration 120 hours.Fifty-one patients were successfully weaned and proximal end of carotid artery was ligated upon ECMO weaning.Conclusion Right carotid artery and internal jugular vein incision and intubation is safe,effective and reliable for pediatric ECMO.However,the learning curve of intubation under CPR remains long.

关 键 词：体外膜肺氧合 导管插入术/方法 儿童 

分 类 号：R651.4[医药卫生—外科学]