体外膜氧合支持下儿童心脏移植分析  

Analysis of pediatric heart transplantation supported by extracorporeal membrane oxygenation

作　　者：赵喆[1] 周成斌[2] 刘爱红 林中林[2] 陈官映 王哲[1] 李迈 吴敏 黄劲松[2] 洪小杨 Zhao Zhe;Zhou Chengbin;Liu Aihong;Lin Zhonglin;Chen Guanying;Wang Zhe;Li Mai;Wu Min;Huang Jinsong;Hong Xiaoyang(Pediatric Intensive Care Unit,Faculty of Pediatrics,the Seventh Medical Center of Chinese People's Liberation Army General Hospital,Beijing 100700,China;Department of Cardiovascular Surgery,Guangdong Provincial Cardiovascular Institute,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangzhou 510080,China)

机构地区：[1]解放军总医院第七医学中心儿科医学部重症医学科,北京100700 [2]广东省人民医院心外科,广州510080

出　　处：《中华儿科杂志》2024年第8期770-774,共5页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2021YFC2701700);首都卫生发展科研专项(2020-2-5093)。

摘　　要：目的总结体外膜氧合(ECMO)支持下终末期心力衰竭患儿行心脏移植的病例特点。方法回顾性分析2019年1月至2023年12月解放军总医院第七医学中心和广东省人民医院于ECMO支持下行心脏移植的12例患儿的临床资料,包括患儿性别、年龄、体重、所患疾病以及ECMO支持前乳酸水平、左心室射血分数(LVEF)及血管活性药物指数(VIS)、术前ECMO支持时间及左心减压等信息。收集全部患儿心脏移植手术相关信息(包括供心冷缺血时间、体外循环时间、术中免疫抑制剂)、术后重复使用ECMO情况、术后ECMO时间以及患儿是否成功脱离ECMO、是否存活出院等,左心减压前后采用配对t检验。结果12例患儿年龄1.1~15.8岁,体重8~63 kg,10例患儿原发病为扩张型心肌病,1例心肌致密化不全,1例SCN5A基因新发杂合突变致重叠综合征并发致死性心律失常,ECMO支持前患儿乳酸0.6~>15.0 mmol/L,LVEF 7%~43%,VIS 3~108分。4例患儿接受经胸小切口左心减压,减压后脉压较减压前有明显提升[(17.8±2.1)比(9.8±1.5)mmHg,1 mmHg=0.133 kPa,t=11.31,P=0.001],LVEF差异无统计学意义[(26.8±4.4)%比(24.9±4.9)%,t=1.75,P=0.178]。术后共有7例患儿再次接受ECMO辅助,其中3例患儿成功脱离ECMO并存活出院。12例接受移植患儿中10例成功脱离ECMO,8例患儿存活转出重症监护病房。结论行ECMO支持的终末期心力衰竭患儿,左心加压能显著改善脉压,最终需接受心脏移植手术。Objective:To summarize the clinical characteristics of patients with end-stage heart failure who receive heart transplant under extracorporeal membrane oxygenation(ECMO)support.Methods:The clinical data of 12 pediatric patients who received heart transplant with ECMO support in the Seventh Medical Center of Chinese People′s Liberation Army General Hospital and Guangdong Provincial People′s Hospital,from January 2019 to December 2023 was collected.The data included sex,age,weight,diagnosis,pre-ECMO lactate level,left ventricular ejection fraction(LVEF),vasoactive-inotropic score(VIS),and preoperative ECMO running time.Surgical data included cold ischemia time of the donor heart,cardiopulmonary bypass time,intraoperative use of immunosuppressant,postoperative use of ECMO,duration of postoperative ECMO,rate of successful weaning from ECMO,and survival discharge rate.The paired t-test was performed to compare cardiac function indices before and after left ventricular decompression.Results:The 12 patients ranged in age from 1.1 to 15.8 years,and weighted from 8 to 63 kg.Ten children were diagnosed with dilated cardiomyopathy,one with myocardial underdensification,and one with a novel heterozygous mutation of the SCN5A gene causing overlap syndrome complicated by fatal arrhythmia.Before ECMO,the lactate ranged from 0.6 to>15.0 mmol/L,the LVEF from 6.5%to 43%,and VIS from 3 to 108.Four patients underwent left ventricular decompression supported by preoperative ECMO,and their pulse pressure was significantly increased after decompression((17.8±2.1)vs.(9.8±1.5)mmHg,1 mmHg=0.133 kPa,t=11.31,P=0.001),while there was no apparent change in LVEF((26.8±4.4)%vs.(24.9±4.9)%,t=1.75,P=0.178).A total of 7 children received a second run of ECMO after surgery and 3 of them successfully weaned off ECMO and survived to discharge.In the entire cohort,10 were successfully weaned from ECMO and 8 survived to discharge.Conclusions:For children with end-stage heart failure supported by ECMO,left ventricular decompression can significa

关 键 词：心力衰竭 体外膜氧合作用 儿童 心脏移植 

分 类 号：R726.5[医药卫生—儿科]