小儿心脏术后难治性出血行体外膜氧合的临床经验  

The application of extracorporeal membrane oxygenation for pediatric post-cardiotomy refractory hemorrhage

作　　者：靳雨 崔勇丽[1] 刘晋萍[1] 冯正义[1] 赵举[1] 赵明霞[1] 胡金晓[1] Jin Yu;Cui Yongli;Liu Jinping;Feng Zhengyi;Zhao Ju;Zhao Mingxia;Hu Jinxiao(Department of Cardiopulmonary Bypass,Fuwai Hospital,National Center for Cardiovascular Diseases,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100037,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院体外循环中心,北京100037

出　　处：《中国体外循环杂志》2021年第4期201-204,共4页Chinese Journal of Extracorporeal Circulation

基　　金：国家自然科学基金(81670375)。

摘　　要：目的总结本院小儿先天性心脏病(CHD)心脏术后难治性出血应用体外膜氧合(ECMO)辅助治疗的临床经验。方法回顾性分析本院2016年4月至2018年11月期间因小儿心脏术后难治性出血应用ECMO辅助治疗的5例患儿,其中男3例,女2例。记录患儿一般资料、ECMO建立前、ECMO期间、ECMO撤机后等相关临床资料,总结心脏术后难治性出血患儿行ECMO管理经验。结果5例患儿在手术间因难治性出血无法维持循环和呼吸功能而行ECMO,均成功脱机,仅1例患儿在撤机2月后因蛋白丢失性肠病死亡,ECMO运行时间88~134 h。结论ECMO是治疗CHD心脏术后难治性出血的有效手段,ECMO建立时机、ECMO期间抗凝管理方案和辅助管理措施是治疗成功的关键。Objective To summarize the clinical experience of extracorporeal membrane oxygenation(ECMO)for post-cardiotomy refractory hemorrhage in children with congenital heart disease.Methods A retrospective analysis was performed in our hospital from April 2016 to November 2018.Five patients were implemented with ECMO for refractory bleeding after pediatric cardiac surgery,including 3 boys and 2 girls.Demographics,clinical characteristics,complications,and the mortality were collected and analyzed.Results Five patients were weaned from ECMO successfully.Only 1 patient died of protein losing enteropathy 2 months after ECMO withdrawal.The ECMO running time was 88-134 hours.Conclusion ECMO is an effective method for post-cardiotomy refractory hemorrhage.The timing of the establishment of ECMO,anticoagulation management and auxiliary management measures during ECMO are the keys to successful treatment.

关 键 词：体外膜氧合 先天性心脏病 心脏术后 难治性出血 小儿 

分 类 号：R726.5[医药卫生—儿科]