体外膜氧合在先天性心脏病儿童危急重症中的应用  

The application of extracorporeal membrane oxygenation in critically ill children with congenital heart disease

作　　者：丁培成 莫绪明[1] 彭卫[1] 陈凤 束亚琴[1] 张玉喜[1] 武开宏[1] 戚继荣[1] 孙剑[1] 邹靓 寸跃爽 王智琪[1] Ding Peicheng;Mo Xuming;Peng Wei;Chen Feng;Shu Yaqin;Zhang Yuxi;Wu Kaihong;Qi Jirong;Sun Jian;Zou Liang;Cun Yueshuang;Wang Zhiqi(Department of Cardiothoracic Surgery,Nanjing Children's Hospital,Nanjing Medical University,Nanjing 210000,China)

机构地区：[1]南京医科大学附属儿童医院心胸外科江苏省先天性心脏病诊疗中心,南京210000

出　　处：《中国体外循环杂志》2021年第4期195-200,共6页Chinese Journal of Extracorporeal Circulation

基　　金：江苏省重点研发计划(社会发展)(BE2017608)。

摘　　要：目的通过分析体外膜氧合(ECMO)技术在本中心先天性心脏病(CHD)儿童围术期应用的临床资料及预后,总结经验为降低ECMO的死亡率、减少并发症提供依据。方法回顾性分析2016年6月至2019年6月41例接受ECMO的CHD围术期患儿的临床资料。本组除1例患儿外均在心肺转流下完成手术,ECMO均采用经胸插管静脉-动脉ECMO(V-A ECMO)模式。结果男26例,女15例。手术年龄46.68(22.94,171.70)d;体重4.10(3.40,6.00)kg。ECMO时间5.15(4.28,6.25)d。成功撤离ECMO 24例(58.5%),治愈出院17例(41.5%)。ECMO期间并发症包括感染22例(53.7%)、急性肾功能不全21例(51.2%)、呼吸功能不全需要机械通气>7 d 14例(34.1%)等。未撤机组术后出现凝血功能障碍的发生率显著高于撤机组(P=0.014);未撤机组术前冠状动脉畸形、肺部疾病的发生率略高于撤机组,无显著性差异(P=0.064、0.141)。死亡组染色体异常、术后残余畸形、术后感染的发生率显著高于存活组(P=0.017、0.038、0.022);死亡组术前心肺复苏、术后心律失常、术后肺炎的发生率略高于存活组(P=0.134、0.061、0.078),无显著性差异。结论ECMO已经成为CHD儿童围术期心肺支持的重要手段。在把握好安装指征的同时,ECMO期间的精细管理,努力降低相关的并发症,是进一步提高撤机率及存活率的关键。Objective To summarize relevant experience to provide basis for further reducing the mortality and the incidence of complications by analyzing the clinical data and prognosis of children with congenital heart disease(CHD)requiring extracorporeal membrane oxygenation(ECMO)in our hospital during the perioperative period.Methods The clinical data of 41 children with CHD during perioperative period requiring ECMO in our hospital from June 2016 to June 2019 were retrospectively reviewed.All the patients except one received surgery under cardiopulmonary bypass(CPB).All the patients were adopted with arterial venous ECMO(V-A ECMO)mode with thoracic intubation.Results Among the 41 children(26 boys and 15 girls,operative age 46.68(22.94,171.70)d,weight 4.10(3.40,6.00)kg,ECMO time 5.15(4.28,6.25)days),24(58.5%)were successfully weaned from ECMO and 17(41.5%)survived to discharge.The incidence of ECMO-related complications was still high,including 22 cases(53.7%)of infection,21(51.2%)cases of acute renal insufficiency,14(34.1%)cases of respiratory insufficiency requiring mechanical ventilation for at least 7 days and so on.Compared with patients with successful ECMO weaning,the incidence of postoperative coagulation dysfunction of patients with unsuccessful ECMO weaning was significantly higher(P=0.014);the incidence of preoperative pulmonary disease and preoperative coronary artery malformation of patients with unsuccessful ECMO weaning was slighter higher with no significant difference(P=0.064,0.141).The incidences of chromosome abnormality,postoperative residual deformity and postoperative infection in the death group were significantly higher than those in the survival group(P=0.017,0.038,0.022).The incidences of preoperative cardiopulmonary resuscitation,postoperative arrhythmia and postoperative pneumonia in the death group were slightly higher than those in the survival group(P=0.134,0.061,0.078),but there was no significant difference.Conclusion ECMO has become an important method of perioperative cardiopulmonary su

关 键 词：体外膜氧合 心肺转流 儿童 先天性心脏病 并发症 

分 类 号：R726.5[医药卫生—儿科]