危重患儿体外膜氧合二级转运的多中心回顾性研究  

A multicenter retrospective study of secondary transport on extracorporeal membrane oxygenation in critically ill children

作　　者：赵喆[1] 程晔 吴小红 刘颖悦 李迈 何小钰 程文哲 王风 郭予雄[4] 张明霞 黄国栋 陆国平 陈雨晗 方柯南 洪小杨 Zhao Zhe;Cheng Ye;Wu Xiaohong;Liu Yingyue;Li Mai;He Xiaoyu;Cheng Wenzhe;Wang Feng;Guo Yuxiong;Zhang Mingxia;Huang Guodong;Lu Guoping;Chen Yuhan;Fang Kenan;Hong Xiaoyang(Pediatric Intensive Care Unit,Faculty of Pediatrics,the Seventh Medical Center of Chinese People′s Liberation Army General Hospital,Beijing 100700,China;Intensive Care Unit,Children′s Hospital of Fudan University,Shanghai 201102,China;Surgical Care Unit of Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children's Hospital,Zhengzhou 450018,China;Pediatric Intensive Care Unit,Guangdong Provincial People′s Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Cardiac Center,Guangzhou Women and Children′s Medical Center,Guangzhou 510623,China;National Engineering Laboratory for Birth Defects Prevention and Control of Key Technology,the Seventh Medical Center of People′s Liberation Army General Hospital,Beijing 100700,China;Pediatric Intensive Care Unit,Luoyang Maternal and Child Health Hospital,Luoyang 471000,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]复旦大学附属儿科医院重症医学科,上海201102 [3]郑州大学附属儿童医院,河南省儿童医院郑州儿童医院外科监护室,郑州450018 [4]南方医科大学附属广东省人民医院(广东省医学科学院)儿科重症监护室,广州510080 [5]广州市妇女儿童医疗中心心脏中心,广州510623 [6]解放军总医院第七医学中心出生缺陷防控关键技术国家工程实验室,北京100700 [7]洛阳市妇幼保健院儿童重症医学科,洛阳471000

出　　处：《中华儿科杂志》2025年第3期243-248,共6页Chinese Journal of Pediatrics

基　　金：国家重点研发计划(2021YFC2701700);洛阳市医疗卫生科技计划项目(2101056A)。

摘　　要：目的探讨体外膜氧合(ECMO)支持危重患儿二级转运的临床安全性及有效性。方法回顾性队列分析。收集5家ECMO中心和中国儿科体外生命支持联盟数据库中于2019年5月至2024年5月的222例ECMO转运患儿病例资料,根据转运性质分为初级转运组和二级转运组,采用两独立样本t检验、Wilcoxon秩和检验和χ^(2)检验或Fisher确切概率法比较两组一般情况、ECMO支持原因、转运距离、转运前实验室检查结果以及预后和并发症等资料。结果222例ECMO转运患儿中男135例、女87例,年龄3.0(0.2,7.0)岁,初级转运组202例,二级转运组20例,二级转运患儿均在当地尝试撤离ECMO失败后启动二级转运。二级转运组患儿ECMO支持年龄、切开置管比例、循环支持比例、支持前乳酸水平均高于初级转运组[7.0(2.8,10.0)比3.0(0.2,6.0)岁、55.0%(11/20)比3.6%(7/202)、80.0%(16/20)比41.6%(84/202)、(10±4)比(7±6)mmol/L,Z=3.41,χ^(2)=66.31、10.99,t=2.24,均P<0.05]。二级转运组循环支持患儿转运前的血管活性药物指数、呼吸支持患儿氧合指数高于初级转运组(83±33比82±68、51.0±1.8比37.4±10.2,t=2.36、2.63,均P<0.05),两组患儿性别、转运距离、ECMO前肌酐、动脉血气碱剩余值及ECMO转流时长差异均无统计学意义(均P>0.05),两组患儿转运过程中均未发生危及生命的并发症。二级转运组有2例患儿接受心脏移植,1例接受射频消融。两组患儿总体存活率差异无统计学意义[45.0%(9/20)比55.4%(112/202),χ^(2)=1.15,P>0.05]。结论儿科ECMO二级转运过程中并未增加病死率及危及生命的并发症发生率,当地无法得到有效治疗的ECMO患儿,二级转运转至高级ECMO中心,可以获得进一步的治疗机会。Objective To evaluate the safety and efficacy of secondary transport on extracorporeal membrane oxygenation(ECMO)for critically ill children.Methods This was a retrospective cohort study.Data from 222 pediatric patients who underwent ECMO transport from May 2019 to May 2024 at 5 ECMO centers and Chinese Database of Pediatric Extracorporeal Life Support Organization were collected.The cases were divided into primary and secondary transport groups by nature of transport.The clinical data,including demographics,ECMO indications,transport distance,pre-transport lab results,prognosis and complications were analyzed.Two independent samples t-test,Wilcoxon test,andχ^(2)test or Fisher′s exact probability method were used to compare the differences between 2 groups and evaluate the safety and efficacy of secondary transport.Results Among the 222 children transported with ECMO,there were 135 males and 87 females,with an age of 3.0(0.2,7.0)years.There were 202 cases in the primary transport group and 20 cases in the secondary transport group.All secondary transport patients had failed attempts at weaning ECMO before transfer.The patients in the secondary transport group were older,had higher rates of surgical cannulation,circulatory support,and pre-ECMO lactate levels compared to the primary transport group(7.0(2.8,10.0)vs.3.0(0.2,6.0)years old,55.0%(11/20)vs.3.6%(7/202),80.0%(16/20)vs.41.6%(84/202),(10±4)vs.(7±6)mmol/L,Z=3.41,χ^(2)=66.31,10.99,t=2.24,all P<0.05).In the secondary transport group,the vasoactive-inotropic scores of patients on circulatory support and the oxygenation index for patients requiring respiratory support were higher than those in the primary transport group(83±33 vs.82±68,51.0±1.8 vs.37.4±10.2,t=2.36,2.63,respectively;both P<0.05).There were no statistically significant differences between the 2 groups in sex,transport distance,pre-ECMO creatinine,arterial blood gas BE values,and ECMO duration(all P>0.05).No life-threatening complications occurred during the transport in either group.Two p

关 键 词：体外膜氧合作用 儿童 病人转送 多中心研究 

分 类 号：R720.597[医药卫生—急诊医学]