儿童ECMO颈动脉保留技术初探  

A preliminary study on thevessel sparing technique used in children applied with an extracorporeal membrane oxygenation

作　　者：王大佳[1] 孙洪利[2] 杨妮[3] 李天宇 许巍[3] 刘春峰[3] Wang Dajia;Sun Hongli;Yang Ni;Li Tianyu;Xu Wei;Liu Chunfeng(Department of Pediatric Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Department of Vascular Surgery,Shengjing Hospital of China Medical University,Shenyang 110004,China;Pediatric Intensive Care Unit,Shengjing Hospital of China Medical University,Shenyang 110004,China)

机构地区：[1]中国医科大学附属盛京医院小儿外科,沈阳110004 [2]中国医科大学附属盛京医院血管疾病外科,沈阳110004 [3]中国医科大学附属盛京医院PICU,沈阳110004

出　　处：《中华小儿外科杂志》2025年第3期212-216,共5页Chinese Journal of Pediatric Surgery

基　　金：辽宁省重点研发计划联合计划项目(2020JH2/10300131)。

摘　　要：目的探讨儿童体外膜氧合(extracorporeal membrane oxygenation,ECMO)成功撤机后颈动脉血管保留技术(vessel sparing technique,VST)的方法与临床效果。方法回顾分析2022年6月至2023年3月中国医科大学附属盛京医院因小儿危重症接受静脉-动脉ECMO治疗的7例患儿资料,其中男2例,女5例;平均年龄为10.8岁。治疗成功撤离ECMO患儿均在PICU床旁采用VST,保留右颈动脉。总结病例的临床特点、手术方法、术后并发症、颈动脉和脑神经功能评价。结果7例患儿ECMO运行中位时间为117 h,中位住院时间为15.8 d,接受右颈动脉修补,6-0无损伤不可吸收缝线连续外翻双层缝合颈动脉,VST手术成功。患儿均痊愈出院,无血管神经副损伤、无导管相关感染,右颈动脉狭窄1例,5例存在血管壁改变,无颅内出血、无颅内栓塞等并发症。随访中位时间为9.5个月,颈动脉无功能性闭塞,脑部MRI和脑电图未见异常,无癫痫、认知与运动功能障碍等脑损伤相关并发症。结论经颈动脉置管的静脉-动脉ECMO患儿可以选择VST颈动脉重建,颈动脉VST手术是安全可行的,临床效果好。Objective To explore the approach and clinical efficacy of vessel sparing technique(VST)after extracorporeal membrane oxygenation(ECMO)in children.Methods The clinical data of 7 children who underwentvenoarterial extracorporeal membrane oxygenation(VA-ECMO)in the Pediatric Intensive Care Unit(PICU)of Shengjing Hospital of China Medical University between June 2022 and March 2023 were analyzed retrospectively,including 2 males and 5 females,with an average age of 10.8 years.All of them were managed by bed-site VST after weaning off ECMO,with the preservation of the right carotid artery.The clinical features,operating procedures,postoperative complications,carotid artery evaluation,and cranial nerve function evaluation were summarized.Results The median ECMO duration was 117 hours and the median hospital stay was 15.8 days.All patients underwent right carotid artery repair,and the carotid artery was closed by continuous valgus double-layer suturing with the 6-0 nonabsorbable suture.VST was successfully performed.All the patients recovered and were discharged without vascular damage,nerve collateral damage,or catheter-related infection.There was 1 case of right carotid artery stenosis,and 5 cases reported vascular wall changes.No intracranial hemorrhages,intracranial embolism,and other complications were observed.All patients were followed up for a median duration of 9.5 months.None of the patients experienced functional occlusion of the carotid artery,abnormalities in head magnetic resonance imaging(MRI)or electroencephalogram(EEG),or complications related to brain injury(for example,epilepsy,cognitive impairment,andmotor dysfunction).Conclusions Carotid artery decannulation by VST can be used for children undergoing VA-ECMO with carotid catheterization.VSTin the carotid artery is safe and feasible,with a favorable clinical outcome.

关 键 词：体外膜氧合作用 颈动脉 儿童 血管保留技术 

分 类 号：R726.5[医药卫生—儿科]