摘要
目的总结先天性膈疝围术期体外膜氧合(ECMO)治疗的临床经验。方法回顾分析6例先天性膈疝(CDH)围术期在本院接受ECMO治疗患儿的临床资料(男3例,女3例,年龄12~74 h,体重2.71~3.88 kg),总结ECMO适应证和时机选择、ECMO下患者转运、手术时机、出血和血栓形成的处理等临床经验。结果本组1例主动脉弓缩窄合并CHD患者因体外循环术后脱机困难转为ECMO,5例患者因围术期低氧血症酸中毒常规处理无效建立ECMO,其中1例患儿经本院ECMO团队会诊后在当地医院建立ECMO,运行平稳后转运至本院;4例术前建立ECMO,内环境改善后在ECMO辅助下行膈肌修补术,术后继续ECMO辅助;1例膈肌修补术后出现肺高压低氧血症,经颈部置管建立静脉-动脉(V-A)ECMO。ECMO辅助时间73~170 h。6例患儿中4例出院,1例ECMO撤离后21 d死于感染性休克,1例ECMO中并发坏死性小肠结肠炎和DIC死亡。主要并发症是出血、血栓形成、毛细血管渗漏。结论ECMO是治疗常规处理无效的CDH围术期低氧血症的有效手段。转运方案、ECMO时机和手术时机选择应根据患儿的疾病状态制定个性化的治疗方案,精准管理包括抗凝、液体管理等的各个环节,有助于减少并发症,提高存活率。
Objective To summarize the clinical experience of extracorporeal membrane oxygenation for perioperative hypoxemia in congenital diaphragmatic hernia.Methods There were six neonates with CDH(three boys and three girls,aged 12 to 74 hours and weighed 2.71~3.88 kg)supported by ECMO in our center.Medical records and patient management notes were retrospectively reviewed.Results One patient was implemented with ECMO owing to failing to wean from cardiopulmonary bypass after operation,5 patients were implemented with ECMO after failing to achieve adequate oxygenation with traditional therapy.One case was implemented with ECMO at local hospital and transferred to our hospital.CDH repair were performed with ECMO in 4 patients and ECMO support were continued after operation.One case was implemented with ECMO after CDH repair operation.ECMO running time was between 73 to 170 hours.Four patients were weaned from ECMO successfully and discharged home.One patient died from neonate enterocolitis and disseminated intravascular coagulation during ECMO.One patient died from septic shock 21 days after ECMO withdrawal.The main complications were bleeding,thrombosis and severe capillary leakage syndrome.Conclusion ECMO is an effective rescue method for CDH which is refractory to conventional treatment.Individualized therapy method including transferring plan,ECMO timing and repair timing depend on patient’s illness state.Appropriate timing of intervention,accurate coagulation and volume management are important factors to improve survival and reduce complications.
作者
叶莉芬
范勇
舒强
林茹
Ye Lifen;Fan Yong;Shu Qiang;Lin Ru(Heart Institute,Children’s Hospital,Zhejiang University School of Medicine,Hangzhou 310000,China)
出处
《中国体外循环杂志》
2019年第6期330-333,共4页
Chinese Journal of Extracorporeal Circulation
基金
2012国家科技支撑计划项目(2012BAI04B05)
2018年度浙江省基础公益研究计划(LGF18H020005)
关键词
先天性膈疝
低氧
体外膜氧合
手术时机
并发症
个性化管理
体外循环
非心脏手术
Congenital diaphragmatic hernia
Hypoxemia
Extracorporeal membrane oxygenation
Operation opportunity
Complication
Personalized accurate manage
Extracorporeal circulation
Non-cardiac surgery
