体外膜肺氧合在先天性膈疝治疗中的应用及进展  

Research advances in using extracorporeal membrane oxygenation for congenital diaphragmatic hernia

作　　者：孟楚怡 马立霜[1] Meng Chuyi;Ma Lishuang(Department of Neonatal Surgery,Affiliated Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院新生儿外科,北京100020

出　　处：《中华小儿外科杂志》2024年第4期367-372,共6页Chinese Journal of Pediatric Surgery

摘　　要：先天性膈疝(congenital diaphragmatic hernia,CDH)是新生儿使用体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)的最常见适应证,CDH患儿生后因严重的肺发育不良和肺动脉高压出现难治性呼吸循环衰竭,可通过ECMO维持呼吸循环功能保障患儿生命。尽管近年来已有大量回顾性研究提出使用ECMO的指征及经验,但是其生存益处与弊端仍存在争议,ECMO对CDH患儿生存率有一定的改善但引发的远期出血并发症风险较大,且缺乏多中心随机对照研究。随着CDH呼吸机支持治疗水平的提高、肺动脉高压靶向药物联合治疗的应用,各医疗中心对ECMO的使用也越来越谨慎。目前ECMO多数情况下在部分重症CDH患儿中应用,且各中心实践标准并不完全一致。现总结目前ECMO在CDH应用的临床指征、插管方式、手术修补时机及禁忌证、预后等相关标准及争议点,对ECMO的相关研究进展进行综述。Congenital diaphragmatic hernia(CDH)is the most common indication for neonatal extracorporeal membrane oxygenation(ECMO).In most severe cases,CDH children suffer lethal cardiac and respiratory failures due to pulmonary dysplasia and pulmonary hypertension.Although a few recent retrospective studies have addressed the indications and applications of ECMO,trade-offs between its survival benefits and drawbacks have remained controversial.It could improve the survival rate of CDH babies.With a higher risk of long-term hemorrhagic complications,there is also a lack of multicenter randomized controlled studies.With optimized ventilator management for CDH and dosing of targeted drugs for pulmonary hypertension,medical institutions have become more and more cautious about timing of using ECMO.It is currently indicated for severe CDH at some medical centers and there is no consensus.This review summarizes the latest advances of clinical indications,intubation duration,contraindications,outcomes and controversies of ECMO application for severe CDH.

关 键 词：疝 横膈 先天性 体外膜肺氧合 适应证 

分 类 号：R726.5[医药卫生—儿科]