超声在体外膜肺氧合治疗儿童急性暴发性心肌炎中的应用价值  

Application value of ultrasound in extracorporeal membrane oxygenation for the treatment of acute fulminant myocarditis in children

作　　者：刘梅[1] 王建华[1] 赵喆[2] 王哲[2] 洪小杨 LIU Mei;WANG Jianhua;ZHAO Zhe;WANG Zhe;HONG Xiaoyang(Department of Ultrasound Diagnosis,the 7th Medical Center of PLA General Hospital,Beijing 100070,China)

机构地区：[1]解放军总医院第七医学中心超声诊断科,北京市100070 [2]解放军总医院第七医学中心儿童医学部,北京市100070

出　　处：《临床超声医学杂志》2023年第1期74-77,共4页Journal of Clinical Ultrasound in Medicine

基　　金：全军后勤科研项目资助(BLJ18J006)。

摘　　要：目的探讨超声在体外膜肺氧合(ECMO)治疗儿童急性暴发性心肌炎中的应用价值。方法选取我中心收治的21例因急性暴发性心肌炎行ECMO治疗并成功脱机的患儿,观察ECMO治疗前和ECMO撤离即刻各超声心动图参数的变化,并监测并发症发生情况。结果21例患儿治疗前的超声心动图表现:17例出现左室壁增厚,心肌回声减低;12例出现少量心包积液;16例出现二、三尖瓣少量反流。与ECMO治疗前比较,ECMO撤离即刻左室射血分数、二尖瓣前叶收缩期运动速度、左室流出道速度时间积分均升高,左室壁厚度、左室舒张末期内径、左房内径均减小,肺动脉收缩压下降,差异均有统计学意义(均P<0.01)。发生的并发症包括:静脉插管位置不当3例,插管位置渗血5例,颈动脉插管处假性动脉瘤1例,插管于右房入口血栓1例,脑组织损伤1例。结论超声可在急性暴发性心肌炎的诊断、ECMO治疗过程中评估心脏功能的变化及监测并发症的发生,具有重要的应用价值。Objective To investigate the application value of ultrasound in extracorporeal membrane oxygenation(ECMO)for the treatment of acute fulminant myocarditis(AFM)in children.Methods Twenty-one children admitted to our center were treated with ECMO for acute fulminant myocarditis and were successfully taken off the machine were selected.The changes of echocardiographic parameters before ECMO treatment and immediately after ECMO withdrawal were observed,and the occurrence of related complications was monitored.Results Echocardiographic manifestations in 21 children:17 cases showed left ventricular wall thickening and hypoechoic myocardium,12 cases showed a small amount of pericardial effusion,and 16 cases showed a small amount of valvular regurgitation.Compared with those before ECMO treatment,the left ventricular ejection fraction,systolic motion velocity of the anterior mitral leaflet,and left ventricular outflow tract velocity time integral were all increased,the left ventricular wall thickness,left ventricular end-diastolic internal diameter,and left atrial internal diameter were all decreased,and the pulmonary artery systolic pressure was decreased immediately after ECMO withdrawal,the differences were statistically significant(all P<0.01).Associated complications that occurred included 3 cases of improperly positioned intravenous cannulation,5 cases of blood leakage at the cannulation site,1 case of pseudoaneurysm at the carotid artery cannulation,1 case of thrombosis at the right atrial entrance by cannulation,and 1 case of brain tissue injury.Conclusion Ultrasound can be invaluable in the diagnosis of acute fulminant myocarditis,as well as in monitoring changes in cardiac function during ECMO treatment and monitoring complications during the treatment.

关 键 词：超声心动描记术 急性暴发性心肌炎 体外膜肺氧合 心脏功能 左 并发症 

分 类 号：R540.45[医药卫生—心血管疾病] R542.2[医药卫生—内科学]