体外膜氧合技术在危重症新生儿救治的临床应用  

The application of extracorporeal membrane oxygenation in the treatment of critically ill neonates

作　　者：李小兵[1] 颜崇兵[2] 崔云[3] 沈立[1] 李佳[1] 张育才[3] 龚小慧[2] 张儒舫[1] Li Xiaobing;Yan Chongbing;Cui Yun;Shen Li;Li Jia;Zhang Yucai;Gong Xiaohui;Zhang Rufang(Department of Pediatric Cardiothoracic Surgery,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心胸外科,上海200062 [2]上海市儿童医院上海交通大学附属儿童医院新生儿科,上海200062 [3]上海市儿童医院上海交通大学附属儿童医院重症医学科,上海200062

出　　处：《中国体外循环杂志》2021年第1期8-12,共5页Chinese Journal of Extracorporeal Circulation

基　　金：上海市科技攻关计划(12411952409)。

摘　　要：目的总结体外膜氧合(ECMO)技术在危重症新生儿救治中的临床应用经验。方法回顾性分析2016年11月至2019年8月,在上海市儿童医院危重症新生儿中实施ECMO支持的11例患儿临床资料,包括患儿的一般资料、临床诊断、实验室指标、ECMO支持过程中各种并发症和住院时间等。结果11例患儿中成功脱机8例,脱机率72.7%,存活6例,存活率54.6%。11例患儿ECMO辅助时间为39~228(95.81±59.31)h,住院时间为4~44(25.00±11.48)d。ECMO撤机时呼吸衰竭组乳酸(Lac)、正性肌力药物评分和氧合指数(OI)较ECMO前均显著降低(P<0.05);心力衰竭组正性肌力药物评分和OI显著降低(P<0.05)。ECMO撤离时,死亡患儿的正性肌力药物评分和OI显著高于生存患儿(P<0.05)。死亡患儿的住院时间较存活患儿短(P<0.05);而存活患儿ECMO撤机时Lac、正性肌力药物评分和OI值较ECMO前有显著性降低(P<0.05)。结论ECMO技术是一种有效的应用于危重症新生儿救治的心肺支持措施,但存在多种并发症发生风险,严格掌握指征,提高ECMO管理水平,降低并发症可提高患儿的撤机率及存活率。Objective To summarize the clinical application experience of extracorporeal membrane oxygenation(ECMO)technology in the treatment of critically ill neonates.Methods The clinical data of 11 critically ill neonates supported with ECMO in Shanghai Children’s Hospital from November 2016 to August 2019 were retrospectively analyzed.The data of general information,clinical diagnosis,laboratory results,procedure of ECMO,various complications,and hospital length of stay were collected.Results Eight cases successfully weaned from ECMO(72.7%),in which six cases survived(54.6%).The ECMO duration was 95.81±59.31 hours(range from 39 to 228 hours),and the length of hospital stay was 25.00±11.48 days(range from 4 to 44 days).Blood lactic acid(Lac),vasoactive-inotropic score and oxygenation index(OI)significantly decreased in respiratory failure group after ECMO weaning(P<0.05).In heart failure group,vasoactive-inotropic score and OI significantly reduced as well after ECMO weaning(P<0.05).Compared with the survival group,the vasoactive-inotropic score and OI were significantly higher(P<0.05)and the hospital length of stay was significantly shorter(P<0.05)in the death group after ECMO weaning.In the survival group,Lac,vasoactive-inotropic score and OI were significantly decreased after ECMO treatment(P<0.05).Conclusion ECMO is an effective supportive measure in the treatment of critically ill neonates,however the risk of complications is still high.It is necessary to grasp the clinical indications,improve the management of ECMO and reduce various complications for the improvement of the weaning and survival rates in critically ill neonates.

关 键 词：新生儿 体外膜氧合 呼吸功能不全 心脏功能不全 体外生命支持 并发症 

分 类 号：R722.1[医药卫生—儿科]