摘要
目的探讨体外膜肺氧合(ECMO)辅助治疗新生儿复杂先天性心脏病(CHD)患儿的效果及存活率。方法回顾性病例对照研究。收集2018年1月至2024年6月在阜外华中心血管病医院手术治疗的新生儿复杂CHD患儿围术期使用ECMO辅助的病例22例,其中男19例,女3例;年龄(10.4±8.7)d(1~26 d);体重(3.1±0.3)kg。复杂CHD类型包括完全型肺静脉异位引流9例(40.9%),主动脉弓离断及重度缩窄8例(36.4%),大动脉转位3例(13.6%),右心室双出口1例(4.5%),心脏肿瘤1例(4.5%)。根据辅助时间分为<5 d组、5~12 d组和>12 d组。数据采用t检验或者χ^(2)检验进行比较。结果成功撤除ECMO 8例(36.4%),存活6例(27.3%)。常规使用ECMO 15例(68.2%),体外心肺复苏抢救使用ECMO 7例(31.8%)。ECMO辅助时间(5.9±3.7)d。死亡组与存活组年龄、体重、性别、疾病组成、手术时间、体外循环时间、阻断时间、辅助时间、血常规、肝肾功能等生化指标、手术前射血分数值、降钙素原和C反应蛋白等感染指标差异均无统计学意义(均P>0.05)。存活组ECMO辅助前24 h最高乳酸(8.1±5.4)mmol/L及辅助后24 h最高乳酸(10.5±7.1)mmol/L均明显低于死亡组[(18.7±9.2)mmol/L,(21.3±8.6)mmol/L](t=2.606,P=0.018;t=2.729,P=0.013)。<5 d组生存率为0/9(0),5~12 d组生存率为6/12(50.0%),>12 d组生存率为0/1(0)。5~12 d组的生存率最高,明显高于<5 d组(χ^(2)=6.300,P=0.012)。结论ECMO辅助治疗是新生儿复杂CHD患儿围术期出现严重循环衰竭的有效治疗手段。ECMO辅助前24 h最高乳酸值及辅助后24 h内最高乳酸值影响存活率。辅助时间5~12 d组存活率最高。
Objective To investigate the effect of extracorporeal membrane oxygenation(ECMO)in assisting neonates with complex congenital heart diseases(CHD)and the survival rate of the patients.Methods A retrospective case-control study was made on 22 newborns with complex CHD assisted by ECMO during the perioperative period in Fuwai Central China Cardiovascular Hospital from January 2018 to June 2024.There were 19 males and 3 females in the newborns included,with an average age of(10.4±8.7)days(range:1-26 days)and an average weight of(3.1±0.3)kg.Complex CHD included total anomalous pulmonary venous connection in 9 cases(40.9%),interrupted aortic arch and coarctation in 8 cases(36.4%),transposition of great arteries in 3 cases(13.6%),double outlet right ventricle in 1 case(4.5%)and cardiac tumor in 1 case(4.5%).The patients were divided into the<5 d group,5-12 d group,and>12 d group according to the duration of ECMO support.Data were compared using the t-test orχ^(2)test.Results There were 8 cases(36.4%)successfully weaned from ECMO support and 6 cases(27.3%)survived.ECMO support was used routinely in 15 cases(68.2%),and for extracorporeal cardiopulmonary resuscitation in 7 cases(31.8%).The duration of ECMO support was(5.9±3.7)days.There were no statistically differences in age,weight,gender,disease composition,operation time,cardiopulmonary bypass time,cross-clamp time,assistant time,blood routine,liver and kidney function and other biochemical indicators,preoperative cardiac ejection fraction value,procalcitonin,C-reactive protein and other infection indicators between the death group and the survival group(all P>0.05).The highest lactate values 24 hours before[(8.1±5.4)mmol/L]and after ECMO support[(10.5±7.1)mmol/L]in the survival group were significantly lower than those in the death group[(18.7±9.2)mmol/L,(21.3±8.6)mmol/L](t=2.606,P=0.018;t=2.729,P=0.013).It was found that the survival rate was 0/9(0)in the<5 d group,6/12(50.0%)in the 5-12 d group,and 0/1(0)in the>12 d group.The survival rate of the 5-12 d group was the highest,which was significantly higher than that of the<5 d group(χ^(2)=6.300,P=0.012).Conclusions ECMO support is an effective treatment for severe circulatory failure in neonates with complex CHD in the perioperative period.The highest lactate levels 24 hours before and after ECMO support affect the survival rate.Patients receiving 5-12 d ECMO support can achieve the highest survival rate.
作者
艾峰
孙静
胡小松
顿艳婷
钱晓亮
华影
李江振
Ai Feng;Sun Jing;Hu Xiaosong;Dun Yanting;Qian Xiaoliang;Hua Ying;Li Jiangzhen(Department of Children′s Heart Center,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People′s Hospital,Central China Fuwai Hospital of Zhengzhou University,National Cardiovascular Disease Center Central China Branch Center,Zhengzhou 450003,China;Department of Cardiac Surgery Operation,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People′s Hospital,Central China Fuwai Hospital of Zhengzhou University,National Cardiovascular Disease Center Central China Branch Center,Zhengzhou 450003,China;Department of Cardiopulmonary Bypass,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People′s Hospital,Central China Fuwai Hospital of Zhengzhou University,National Cardiovascular Disease Center Central China Branch Center,Zhengzhou 450003,China)
出处
《中华实用儿科临床杂志》
北大核心
2025年第6期457-460,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
河南省医学科技攻关计划联合共建项目(LHGJ20230158)。
关键词
体外膜肺氧合
复杂先天性心脏病
婴儿
新生
存活率
Extracorporeal membrane oxygenation
Complex congenital heart disease
Infant,newborn
Survival rate
