体外膜肺氧合联合连续肾脏替代治疗救治新生儿胎粪吸入综合征合并持续性肺动脉高压和肺出血一例  

Extracorporeal membrane oxygenation combined with continuous renal replacement therapy in a neonate with meconium aspiration syndrome complicated by persistent pulmonary hypertension and pulmonary hemorrhage

作　　者：许景林[1] 陈冬梅[1] 王瑞泉[1] 吴联强[1] 何伦德[2] 阮俊贤 张伟峰[1] 李晓庆[1] Xu Jinglin;Chen Dongmei;Wang Ruiquan;Wu Lianqiang;He Lunde;Ruan Junxian;Zhang Weifeng;Li Xiaoqing(Department of Neonatology,Quanzhou Women and Children′s Hospital,Quanzhou 362000,China;Department of Cardiac Surgery,Quanzhou Women and Children′s Hospital,Quanzhou 362000,China;Department of Ultrasound,Quanzhou Women and Children′s Hospital,Quanzhou 362000,China)

机构地区：[1]泉州市儿童医院新生儿科,362000 [2]泉州市儿童医院心外科,362000 [3]泉州市儿童医院超声科,362000

出　　处：《中华围产医学杂志》2020年第12期834-837,共4页Chinese Journal of Perinatal Medicine

摘　　要：本文报道了体外膜肺氧合联合连续肾脏替代治疗救治1例危重症新生儿的经过。该例患儿系生后2 h+男婴,因窒息复苏后气促、呻吟伴全身发绀收入泉州市儿童医院,入院诊断为新生儿胎粪吸入综合征合并肺出血、持续性肺动脉高压,经高频机械通气、肺表面活性物质应用及一氧化氮吸入等常规治疗后,仍存在持续低氧血症,并逐渐出现心功能不全及急性肾功能损伤。经慎重抉择并在家属同意下启动体外膜肺氧合联合连续肾脏替代治疗,最终撤机后37 d患儿治愈出院。出院3个月门诊随访,其生长发育正常,颅脑MRI平扫及弥散加权成像未见异常。This article reports the management of a critically ill neonate,who required extracorporeal membrane oxygenation(ECMO)with continuous renal replacement therapy(CRRT).The baby boy was admitted to Quanzhou Women and Children's Hospital from a local setting 2 h+after birth due to"a 2-hour cyanosis,shortness of breath and moaning after resuscitation",and was diagnosed as neonatal meconium aspiration syndrome complicated by pulmonary hemorrhage and persistent pulmonary hypertension.Persistent hypoxemia with worsening cardiac insufficiency and acute kidney damage occurred despite high frequency ventilation,application of pulmonary surfactant,nitric oxide inhalation and other conventional treatments.With the consent of the family,the baby was treated with ECMO combined with CRRT and was ultimately recovered and discharged 37 d after ECMO weaning.During a 3-month follow-up,the patient showed normal growth and development with no abnormalities in the cranial MRI plain scanning and diffusion-weighted imaging.

关 键 词：胎粪吸入综合征 持续性胎儿循环综合征 肺疾病 出血 急性肾损伤 体外膜氧合作用 肾替代疗法 婴儿 新生 

分 类 号：R722.1[医药卫生—儿科]