先天性心脏病手术后残余解剖畸形患者体外膜肺氧合支持的效果分析  

ECMO in patients with residual lesions after cardiac surgery.

作　　者：刘明璐 杨寅愉 张蔚[1] 姜磊 沈佳[1] 郭铮 于新迪[1] 黄坚鹄 王伟[1] Liu Minglu;Yang Yinyu;Zhang Wei;Jiang Lei;Shen Jia;Guo Zheng;Yu Xindi;Huang Jianhu;Wang Wei(Department of Pediatric Cardiothoracic Surgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China.)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海市200127

出　　处：《临床小儿外科杂志》2021年第6期518-524,共7页Journal of Clinical Pediatric Surgery

基　　金：国家自然科学基金(编号:82070430)。

摘　　要：目的总结小儿先天性心脏病手术后存在残余解剖畸形的患者接受体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持的临床结局。方法回顾性分析上海儿童医学中心2017年1月1日至2020年6月30日接受ECMO支持的先天性心脏病手术后患者的临床资料及预后情况,分析残余解剖畸形和后续处理方式对其转归的影响。根据是否存在残余解剖畸形分为残余组(n=26)和非残余组(n=106),再将26例残余解剖畸形患者是否再次进行手术干预分为干预组(n=6)和非干预组(n=20)。结果在132例接受ECMO支持的术后患者中,26例(19.69%)发现存在残余解剖畸形,其中简单先心病(2例),复杂先心病(24例);主要解剖畸形为瓣膜问题(13例),残余梗阻(12例)和残余分流(5例),部分患者有多种畸形。残余组ECMO支持时间(5.26±2.17)d,明显长于非残余组的(3.96±2.77)d,差异有统计学意义(t=2.241,P=0.027);残余组病死率为80.77%,高于非残余组的45.28%,差异有统计学意义(χ^(2)=10.539,P=0.001)。26例有残余解剖畸形患者中6例进行了手术干预,干预组的存活率为50%,高于非干预组的10%(χ^(2)=4.754,P=0.029)。本组病例的死亡原因主要是低心排出量综合征、呼吸系统并发症、多器官功能衰竭和心律失常,存活者均为双心室修补的患者。结论小儿先天性心脏病术后需要ECMO支持的患者应积极评估是否存在残余解剖畸形,尽早发现残余解剖畸形并行手术干预以改善临床预后。Objective To explore the clinical outcomes of extracorporeal membrane oxygenation(ECMO)in children with residual lesions after congenital heart surgery.Methods Clinical data and prognosis were analyzed for postoperative residual anatomic malformations in 132 children with congenital heart disease(CHD)supported by ECMO from January 1,2017 to June 30,2020.The effects of residual anatomical deformities and follow-up treatment on the outcomes were examined.Based upon the presence or absence of residual anatomic malformation,they were assigned into residual group(n=26)and non-residual group(n=106).Then according to the necessity of surgical intervantion,the former group was further divided into intervention sub-group(n=6)and non-intervention sub-group(n=20).Results Among them,26 patients(19.69%)had residual anatomical deformities of valve problems(n=13),residual obstruction(n=12)and residual shunt(n=5).Children with residual anatomical malformation,ECMO support time(5.26±2.77)days was significantly longer than(3.96±2.77)days for those without residual anatomical malformation.And the difference was statistically significant(t=2.241,P=0.027);children with residual anatomy ablation had a mortality rate of 80.77%and it was higher than 45.28%for those without residual anatomy and the difference was statistically significant(χ^(2)=10.539,P=0.001).Twenty-six children with residual anatomy underwent surgical interventions.And the survival rate of intervention group was 50%and it was significantly higher than 10%of non-intervention group(χ^(2)=4.754,P=0.029).The major causes of mortality were low cardiac output syndrome,respiratory complications,multiple organ failure and arrhythmia.All survivors were those undergoing biventricular repair.Conclusion There is a certain probability of residual anatomic malformations in postoperative CHD children requiring ECMO.It is necessary to actively evaluate the existence of residual anatomic malformations.Early detection of residual anatomic malformations and surgical intervention help

关 键 词：心脏缺损 先天性/外科学 心脏缺损 先天性/并发症 病理状态 解剖学 体外膜氧合 治疗结果 

分 类 号：R541.1[医药卫生—心血管疾病] R493.28[医药卫生—内科学]