先天性心脏病术后体外膜氧合支持的新生儿早期神经发育结果  

Early neurodevelopmental outcomes in neonates with extracorporeal membrane oxygenation after operation of congenital heart disease

作　　者：于新迪[1] 杨寅愉 沈佳[1] 张蔚[1] 董媛媛 王伟[1] Yu Xindi;Yang Yinyu;Shen Jia;Zhang Wei;Dong Yuanyuan;Wang Wei(Thoracic&Cardiovascular Surgery Department,Shanghai Children's Medical Center,Shanghai Jiao Tong University School of Medicine,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200127 [2]上海交通大学医学院附属上海儿童医学中心儿童健康管理研究所

出　　处：《中国体外循环杂志》2021年第5期275-278,288,共5页Chinese Journal of Extracorporeal Circulation

摘　　要：目的总结先天性心脏病术后给予体外膜氧合(ECMO)辅助并存活的新生儿早期神经发育的随访结果。方法回顾性分析2017~2019年本院先天性心脏病术后ECMO支持的新生儿早期随访资料,包括神经系统功能、心脏基础疾病和生长发育情况。结果随访ECMO支持后1~3年的11例患儿,男7例、女4例,ECMO启用时年龄0~27 d,体重2.3~4.1 kg。7例(63.64%)患儿的头颅MRI结果有异常,包括陈旧性脑出血2例、脑室增大和脑沟加深4例、白质减少1例。和正常组相比,异常组年龄小、体重低、ECMO前乳酸浓度高、ECPR发生率和深低温停循环的比例高(P<0.05)。格里菲斯评估发现11例患儿的55项领域中有21项(38.18%)的发育商结果在临界状态以下。结论早期随访结果提示年龄偏低、体重低于3.5 kg、ECMO前乳酸浓度高、体外心脏复苏、深低温停循环的新生儿ECMO术后神经系统受损的发生率较高,严重影响患儿的预后。但心脏ECMO后的神经发育问题有待更深入的远期随访研究。Objective To summarize the early neurodevelopmental outcomes of neonates who were treated with ECMO after op⁃eration of congenital heart disease.Methods A retrospective analysis was performed on the neurodevelopmental outcomes in neonates who were supported with ECMO in Shanghai Children's medical center from 2017 to 2019.Nervous system function,primary heart dis⁃ease,and the growth and development were included.Results A total of 11 children were followed up for 1 to 3 years after dis⁃charge,including 7 males and 4 females,aged from 0 to 27 days and weighting between 2.3 to 4.1 kg.Cranial MRI showed that 7 cases(63.64%)had neurological complications,including 2 cases of intracerebral hemorrhage,4 cases of ventricular enlargement and sul⁃cus deepening,and 1 case of reduction of the white matter.Compared with the normal group,the abnormal group had lower age,lower body weight(≤3.5 kg),higher lactate value before ECMO,higher ratios of ECPR and deep hypothermia circulatory arrest(P<0.05).Intelligence assessment found that 21 of the 55 fields(38.18%)of the developmental quotient were below the critical state.Conclusion Early results show that the neonates with lower age,lower body weight(≤3.5 kg),higher lactate value before ECMO,higher ratios of ECPR and deep hypothermia circulatory arrest may have a higher incidence of neurological damage after ECMO,which can affect the prognosis of the neonates seriously.However,neonates supported with ECMO for cardiac indications warrant close neurodevelopmental follow-up.

关 键 词：新生儿 体外膜氧合 神经发育 先天性心脏病 随访 

分 类 号：R654.2[医药卫生—外科学]