体外膜肺氧合治疗28例危重新生儿临床分析  

Clinical analysis of 28 critically ill neonates treated with extracorporeal membrane oxygenation

作　　者：杨慧琛 程倩 方丽 刘仙萍 欧阳夏 林云峰[1] Yang Huichen;Cheng Qian;Fang Li;Liu Xianping;Ouyang Xia;Lin Yunfeng(Department of Neonatology,Fujian Children's Hospital(Fujian Branch of Shanghai Children's Medical Center),College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350011,China;Department of Neonatology,Fujian Maternity and Child Health Hospital College of Clinical Medicine for Obstetrics&Gynecology and Pediatrics,Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建省儿童医院(上海儿童医学中心福建医院),福建医科大学妇儿临床医学院新生儿科,福州350011 [2]福建省妇幼保健院新生儿科,福州350005

出　　处：《中华新生儿科杂志（中英文）》2024年第5期283-288,共6页Chinese Journal of Neonatology

基　　金：福建医科大学启航基金项目(2022QH1748)。

摘　　要：目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在危重新生儿治疗中的有效性和安全性。方法回顾性分析福建省儿童医院及福建省妇幼保健院2021年4月至2023年4月接受ECMO治疗的危重新生儿病例资料,总结使用ECMO的诊疗过程、结局和并发症。结果共纳入28例,男21例,女7例;平均出生体重3187 g(1760~4100 g)。原发病为新生儿持续性肺动脉高压23例(合并急性呼吸窘迫综合征13例,先天性心脏病6例,先天性膈疝3例,胎粪吸入综合征1例),心脏手术后低心排综合征2例,极重度贫血2例,心律失常1例。28例患儿均采用静脉-动脉ECMO模式。ECMO开始时间为生后37.0(19.5,93.8)h,77.3%入院后24 h内开始,ECMO运行时间79.5(46.0,96.8)h,住院时间23.0(6.5,29.5)d。20例(71.4%)ECMO成功撤机。ECMO治疗24 h后血管活性药物评分、氧合指数及血乳酸均较治疗前明显下降,差异有统计学意义(P<0.05)。28例患儿均有不同程度的血小板减少(最低24×109/L)和血红蛋白下降(最低68 g/L),其他并发症包括肾功能不全及液体超载17例、机械装置相关并发症8例、神经系统并发症10例。结论对于新生儿持续性肺动脉高压等重症新生儿,ECMO治疗可以有效改善患儿呼吸和循环功能,但易合并不同程度的并发症。Objective To study the clinical application,effectiveness,and safety of extracorporeal membrane oxygenation(ECMO)in the management of critically ill neonates.Methods The clinical data of critically ill neonates who underwent ECMO treatment at Fujian Children's Hospital and Fujian Maternal and Child Health Hospital between April 2021 and April 2023 were retrospectively analyzed.We summarize the diagnostic and therapeutic process,outcomes,and complications associated with the management.Results A total of 28 cases were included,consisting of 21 males and 7 females.The average birth weight of the participants was 3187 g,with a range of 1760 to 4100 g.23 were diagnosed with neonatal persistent pulmonary hypertension as the primary disease,with 13 cases complicated by acute respiratory distress syndrome,6 cases of congenital heart disease,3 cases of congenital diaphragmatic hernia,and 1 case of meconium aspiration syndrome.Additionally,the primary diseases included 2 cases of low cardiac output syndrome after cardiac surgery,2 cases of extremely severe anemia,and 1 case of arrhythmia.All 28 patients were treated with venoarterial ECMO.ECMO started at 37.0(19.5,93.8)h after birth,with 77.3%began within 24 h after admission.The ECMO running time was 79.5(46.0,96.8)h,while the average duration of hospitalization was 23.0(6.5,29.5)d.20(71.4%)patients were successfully withdrawn from the ECMO device.After 24 h of ECMO treatment,the vasoactive inotrope score,oxygenation index,and blood lactate all decreased compared to pre-treatment values,and the differences were statistically significant(P<0.05).All 28 neonates experienced varying degrees of thrombocytopenia(lowest at 24×109/L)and decreased hemoglobin levels(lowest at 68 g/L).Other complications included renal dysfunction and fluid overload in 17 cases,device-related complications in 8 cases,and neurological complications in 10 cases.Conclusions For critically ill neonates,such as those with persistent pulmonary hypertension of the newborn,ECMO treatment can effectively

关 键 词：体外膜肺氧合 新生儿持续性肺动脉高压 新生儿 

分 类 号：R722.1[医药卫生—儿科]