循环支持的体外膜氧合技术在儿科重症疾病中的应用  

Clinical application of circulation-supported extracorporeal membrane oxygenation in pediatric critical diseases

作　　者：吴柯叶 孟保英[1] 周星 张设设 吴文智 刘怀普[1] Wu Keye;Meng Baoying;Zhou Xing;Zhang Sheshe;Wu Wenzhi;Liu Huaipu(Department of Cardiothoracic Surgery,Shenzhen Children's Hospital,Shenzhen 518038,China)

机构地区：[1]深圳市儿童医院胸心外科,深圳518038

出　　处：《中国体外循环杂志》2022年第2期83-85,106,共4页Chinese Journal of Extracorporeal Circulation

基　　金：深圳市医疗卫生三名工程项目(SZSM201612003);深圳市医学重点学科建设经费资助(SZXK036)。

摘　　要：目的 总结循环支持的体外膜氧合(ECMO)技术在儿科重症疾病中临床应用的经验。方法 收集本院ECMO团队于2017年1月至2020年12月采用循环支持的ECMO治疗的14例儿科重症病例,回顾性分析与总结其临床资料。结果 共14例行循环支持ECMO治疗的患儿,其中男性6例(42.9%);置管时平均年龄为(6.9±4.2)岁;平均体重(26.7±13.8)kg;均为静脉-动脉(V-A)ECMO模式;ECMO中位时间为4(2,9)d;套包更换率14.2%,最长套包使用时间26 d;成功撤机率50%,出院存活率50%;病种:暴发性心肌炎8例,其中2例死亡;休克3例,其中2例死亡;体外心肺复苏2例,均死亡;先天性心脏病术后1例,死亡。出现并发症包括静脉血栓2例,肢端缺血1例,颅内出血1例。结论 ECMO辅助治疗可以为循环衰竭的重症患儿提供有效的循环支持,暴发性心肌炎患儿整体成活率及预后较好,但对于合并其他系统疾病的病情较复杂的患儿,成活率及预后较差。Objective To summarize the experience of clinical application of circulation-supported extracorporeal membrane oxygenation(ECMO) in pediatric critical diseases. Methods We retrospectively analyzed the data of 14 pediatric patients treated with circulation-supported ECMO from January 2017 to December 2020. Results A total of 14 children underwent circulation-supported ECMO, of which 6(42.9%) were male. The average age was(6.9±4.2) years, and the average weight was(26.7±13.8) kg. All children were performed with V-A ECMO, and the median ECMO time was 4(2, 9) days. Package replacement rate was 14.2%, and the longest use time of package was 26 days. The success rate of weaning off from ECMO was 50%, and the discharge survival rate was 50%. 8 cases of fulminant myocarditis were included, and 2 of them died;3 cases of shock were included, and 2 of them died;2 cases of extracorporeal cardiopulmonary resuscitation(ECPR) were included, and they were both died;1 case of congenital heart disease died after ECMO. Complications occurred, including 2 cases of venous thrombosis, 1 case of extremity ischemia, and 1 case of intracranial hemorrhage. Conclusion ECMO can provide effective circulatory support for critical children with circulatory failure. The overall survival rate and prognosis of children with fulminant myocarditis are good, but for children with complicated conditions combined with other systemic diseases, the survival rate and prognosis are poor.

关 键 词：体外膜氧合 动脉-静脉模式 儿科重症疾病 暴发性心肌炎 

分 类 号：R720.597[医药卫生—急诊医学]