体外心肺复苏在中国心搏骤停患儿中应用的现况调查  

Survey on the application of external cardiopulmonary resuscitation in Chinese children with sudden cardiac arrest

作　　者：杨雪 程晔 洪小杨[2] 郭予雄[3] 王旭 杨寅愉 楚建平[6] 靳有鹏[7] 成怡冰 张育才[9] 陆国平 Yang Xue;Cheng Ye;Hong Xiaoyang;Guo Yuxiong;Wang Xu;Yang Yinyu;Chu Jianping;Jin Youpeng;Cheng Yibing;Zhang Yucai;Lu Guoping(Department of Critical Care Medicine,Children′s Hospital of Fudan University,Shanghai 201102,China;Department of Critical Care Medicine,Bayi Children′s Hospital of Beijing Military General Hospital,Beijing 100010,China;Pediatric Intensive Care Unit,Guangdong Provincial People′s Hospital,Guangzhou 519041,China;Department of Pediatric Surgery,Fuwai Hospital of Chinese Academy of Medical Sciences,Beijing 100037,China;Department of Cardiothoracic Surgery,Shanghai Children′s Medical Center,Shanghai 200127,China;Department of Critical Care Medicine,Xi′an Children′s Hospital,Xi′an 710002,China;Pediatric Intensive Care Unit,Shandong Provincial Hospital,Jinan 250021,China;Department of Critical Care Medicine,Henan Children′s Hospital,Zhengzhou 451161,China;Department of Critical Care Medicine,Children′s Hospital of Shanghai,Shanghai 200062,China)

机构地区：[1]复旦大学附属儿科医院重症医学科,上海201102 [2]北京军区总医院附属八一儿童医院重症医学科,北京100010 [3]广东省人民医院儿科重症监护室,广州519041 [4]中国医学科学院阜外医院小儿外科,北京100037 [5]上海交通大学附属上海儿童医学中心心胸外科,上海200127 [6]西安市儿童医院重症医学科,西安710002 [7]山东省立医院儿童重症监护室,济南250021 [8]河南省儿童医院重症医学科,郑州451161 [9]上海市儿童医院重症医学科,上海200062

出　　处：《中华儿科杂志》2023年第11期1018-1023,共6页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2021YFC2701800,2021YFC2701805);上海市科技重大专项(ZD2021CY001);上海市医学创新研究专项(20Y11900600)。

摘　　要：目的了解体外心肺复苏(ECPR)在心搏骤停患儿中的应用现况及实施困难。方法横断面调查35家医院,设计“儿童ECPR信息调查表”(简称调查表),共收集33家医院385例进行ECPR患儿的信息,对中国儿童ECPR技术开展情况、体外膜氧合(ECMO)机器管理、ECPR指征把控、ECPR实施困难等进行现况调查。根据进行ECPR患儿年龄、调查单位地区分布及调查单位性质进行分组比较撤机、出院存活率。采用χ^(2)检验和单因素方差分析进行组间比较,使用LSD法进行事后检验,两两比较使用Bonferroni法进行检验水准调整。结果385例进行ECPR患儿中男224例、女161例。撤机存活185例(48.1%),出院存活157例(40.8%)。因心脏疾病行ECPR的患儿最多为324例(84.2%),因呼吸衰竭行ECPR的患儿为27例(7.0%)。进行ECPR患儿首要的死亡原因为循环衰竭82例(35.9%),其次为脑功能衰竭80例(35.0%)。ECPR最常见实施地点仍为重症监护病房(ICU)(278例,72.2%),ECPR时置管多为切开置管(327例,84.9%)。32家(91.4%)医院已设立ECMO应急小组,ECMO机器共有125台,主要分布于ICU(89台,71.2%),绝大多数医院(32家,91.4%)未备有提前预充的环路。不同年龄段、不同地区及不同性质医院间进行ECPR患儿的撤机存活率及出院存活率差异均无统计学意义(均P>0.05)。非ICU环境下没有配备ECMO机器(16次)、心肺复苏下置管有难度(15次)、从CPR到ECMO转流时间间隔过长(13次)、没有常规配备备用的ECMO环路(10次)、ECMO应急团队无法快速到达现场(5次)被认为是排在前5位的非ICU环境下ECPR实施的难点。结论ECPR已在我国儿科领域逐步开展,需要进一步规范化操作与管理,非ICU环境下的ECPR仍是难点。Objectives To investigate the current application status and implementation difficulties of extracorporeal cardiopulmonary resuscitation(ECPR)in children with sudden cardiac arrest.Methods This cross-sectional survey was conducted in 35 hospitals.A Children′s ECPR Information Questionnaire on the implementation status of ECPR technology(abbreviated as the questionnaire)was designed,to collect the data of 385 children treated with ECPR in the 35 hospitals.The survey extracted the information about development of ECPR,the maintenance of extracorporeal membrane oxygenation(ECMO)machine,the indication of ECPR,and the difficulties of implementation in China.These ECPR patients were grouped based on their age,the hospital location and level,to compare the survival rates after weaning and discharge.The statistical analysis used Chi-square test and one-way analysis of variance for the comparison between the groups,LSD method for post hoc testing,and Bonferroni method for pairwise comparison.Results Of the 385 ECPR cases,224 were males and 161 females.There were 185(48.1%)survival cases after weaning and 157(40.8%)after discharge.There were 324 children(84.2%)receiving ECPR for cardiac disease and 27 children(7.0%)for respiratory failure.The primary cause of death in ECPR patients was circulatory failure(82 cases,35.9%),followed by brain failure(80 cases,35.0%).The most common place of ECPR was intensive care unit(ICU)(278 cases,72.2%);ECPR catheters were mostly inserted through incision(327 cases,84.9%).There were 32 hospitals(91.4%)had established ECMO emergency teams,holding 125 ECMO machines in total.ECMO machines mainly located in ICU(89 pieces,71.2%),and the majority of hospitals(32 units,91.4%)did not have pre-charged loops.There were no statistically significant differences in the post-withdrawal and post-discharge survival rates of ECPR patients among different age groups,regions,and hospitals(all P>0.05).The top 5 difficulties in implementing ECPR in non-ICU environments were lack of ECMO machines(16 times),di

关 键 词：儿童 心肺复苏术 心脏停搏 导管插入术 

分 类 号：R725.4[医药卫生—儿科]