摘要
目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在复杂先天性心脏病(congential heart disease,CHD)围手术期间应用的临床效果。方法收集2017年12月至2022年12月阜外华中心血管病医院复杂CHD患儿围手术期使用ECMO支持治疗的52例患儿的临床资料,其中男30例,女22例;年龄为(21.9±44.1)个月,年龄范围为1 d至14岁。其中新生儿16例,体重为(8.6±10.3)kg。辅助复杂CHD有完全型肺静脉异位引流10例,主动脉弓离断及缩窄9例,大动脉转位6例,肺动脉闭锁5例,右室双出口4例,法洛四联症4例,单心室3例,主动脉瓣狭窄3例,房室间隔缺损3例,冠脉起源异常3例,共同动脉干1例,心脏肿瘤1例。收集患儿的手术时间、体外循环时间、阻断时间、ECMO辅助时长、血常规、肝肾功能等生化指标、术前射血分数(ejection fraction,EF)值、降钙素原和C反应蛋白等指标。患儿出院后定期门诊随访(1个月,3个月,6个月,1年,1年以后每年随访1次),彩色多普勒超声复查心脏。采用SPSS 26.0软件进行数据分析,计量资料采用方差分析及t检验进行比较,计数资料采用卡方检验进行比较。结果成功撤除ECMO有27例(51.9%,27/52),存活有19例(36.5%,19/52)。常规使用ECMO有32例,体外心肺复苏(extracorporeal cardiopulmonary resuscitation,ECPR)使用ECMO有20例。所有患儿的手术时间为(362.9±126.7)min,体外循环时间为(215.8±80.1)min,阻断时间为(106.9±46.6)min,ECMO支持时间为(7.4±7.5)d。死亡组与存活组在年龄、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、EF值、降钙素原和C反应蛋白等指标方面的差异没有统计学意义(均P>0.05)。在ECMO辅助前24 h最高乳酸[(14.5±8.2)mmol/L比(7.6±6.4)mmol/L]、辅助后24 h内最高乳酸[(17.9±8.3)mmol/L比(9.3±7.9)mmol/L]、肾功能衰竭比例(81.8%比42.1%)、腹膜透析比例(81.8%比36.8%)、血液透析比例(30.3%比5.2%)方面,死亡组均明显高于存活组,差异均具有统计学意义(均P<0.05)。死亡组ECPR比例明显高于存活组(51.5%比15.7%),差异有统计学意义(P=0.024)。18例患儿成功随访了17例,随访时间为(31.1±14.8)个月,无死亡病例,1例患儿4年后因心功能不全再次入院,2例患儿行二次手术治疗,2例患儿行介入球囊扩张治疗,其余的患儿均为心功能Ⅰ级。结论ECMO辅助支持治疗是复杂CHD患儿围手术期出现严重循环衰竭的有效治疗手段,可提高复杂CHD患儿的生存率,尽早决定并实施ECMO可避免ECPR的发生。
ObjectiveTo explore the clinical efficacy of extracorporeal membrane oxygenation(ECMO)during the perioperative period of complex congenital heart diseases(CHD).MethodsClinical date of 52 cases with complex CHD using ECMO during the perioperative period treated in the Fuwai Central China Cardiovascular Hospital from December 2017 to December 2022 were collected.There were 30 males and 22 females,with an average age of(21.9±44.1)months,ranging from 1 day to 14 years old.Among them,there were 16 neonates,with an average weight of(8.6±10.3)kg.Among patients with complex CHD who received assistant treatment of ECMO,there were 10 cases of total anomalous pulmonary venous connection,9 cases of interrupted aortic arch and coarctation,6 cases of transposition of great arteries,5 cases of pulmonary atresia,4 cases of double outlet right ventricle,4 cases of tetralogy of Fallot,3 cases of single ventricle,3 cases of aortic valve stenosis,3 cases of atrioventricular septal defect,3 cases of abnormal coronary origin,1 case of common arterial trunk,and 1 case of cardiac tumor.Operation time,cardiopulmonary bypass time,occlusion time,ECMO assistance duration,blood routine test,liver and kidney functions,and preoperative ejection fraction(EF),procalcitonin(PCT)and C-reactive protein(CRP)were collected.Patients were regularly followed up after discharge at 1,3,6 and 12 months,and once every year since the second year of discharge.The color Doppler ultrasound was performed for reexamination.Data analysis was conducted using SPSS 26.0 software.Measurement data were compared using t-test,and enumeration data were compared using chi-square test.ResultsA total of 27/52(51.9%)cases successfully weaned off,and 19/52(36.5%)survived.Conventional ECMO was used in 32 cases,and 20 used ECMO during extracorporeal cardiopulmonary resuscitation(ECPR).The operation time,cardiopulmonary bypass time,Cross-clamp time,and the duration of assisted treatment of ECMO were(362.9±126.7)min,(215.8±80.1)min,(106.9±46.6)min,and(7.4±7.5)d,respectively.There were no significant 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 EF,PCT,CRP and other infection indicators between the death group and the survival group(P>0.05).The highest lactate values 24 h before ECMO[(14.5±8.2)mmol/L vs.(7.6±6.4)mmol/L],the highest lactate values 24 h after ECMO[(17.9±8.3)mmol/L vs.(9.3±7.9)mmol/L],the proportion of renal failure(81.8%vs.42.1%),peritoneal dialysis(81.8%vs.36.8%)and hemodialysis(30.3%vs.5.2%)in the death group were significantly higher than those in the survival group(P<0.05).The proportion of ECPR in the death group was significantly higher than that in the survival group(51.5%vs.15.7%,P=0.024).Among the 18 children,17 were successfully followed up.The follow-up period was(31.1±14.8)months.There were no deaths.One child was readmitted to the hospital due to cardiac insufficiency 4 years later.Two children underwent secondary surgical treatment,and two children received interventional balloon dilation therapy.Cardiac function of other patients was grade I.ConclusionsECMO-assisted supportive therapy is an effective treatment for severe circulatory failure in children with complex CHD during the perioperative period,which can improve the survival rate of children with complex CHD.Early decision and implementation of ECMO can prevent the occurrence of ECPR.
作者
胡小松
华影
钱晓亮
艾峰
李江振
王露露
Hu Xiaosong;Hua Ying;Qian Xiaoliang;Ai Feng;Li Jiangzhen;Wang Lulu(Department of Children's Heart Center,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital Affiliated to Zhengzhou University,Central China Subcenter of National Center for Cardiovascular Diseases,Zhengzhou 450000,China;Department of Cardiopulmonary Bypass,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital Affiliated to Zhengzhou University,Central China Subcenter of National Center for Cardiovascular Diseases,Zhengzhou)
出处
《中华小儿外科杂志》
北大核心
2025年第11期981-986,共6页
Chinese Journal of Pediatric Surgery
基金
河南省医学科技攻关计划联合共建项目(LHGJ20230158)。
关键词
体外膜氧合作用
先天性心脏病
存活率
儿童
Extracorporeal membrane oxygenation
Congenital heart disease
Survival rate
Child
