12例心脏病术后患儿体外膜肺的临床结果及经验

Clinical outcomes and experience of 12 postoperative cardiac sungical children managed with extracorporeal membrane oxygenation

目的回顾性总结分析阜外心血管病医院12例儿童体外膜肺氧合（ECMO）支持治疗的临床结果和经验。方法2004年12月～2005年12月共实施儿童ECMO病例12例，所有患儿均使用Medtronic ECMO系统，管道、氧合器及离心泵内膜采用全肝素涂抹技术，行静脉-动脉ECMO辅助。激活凝血时间维持146～258S，肝素用量5～20U／（kg·h）。辅助期间平均流量在40～220ml／（kg·min）。结果ECMO支持时间55～266h，平均120h；9例（75％）顺利撤离ECMO，其中6例康复出院（67％），3例术后死亡，3例不能撤离ECMO而放弃治疗；总出院率为50％（6／12）。存活出院患儿EC，MO前的动脉血乳酸水平明显低于死亡患儿（P=0．022），两组患儿体重也存在统计学差异（P=0．019）。结论ECMO支持在儿童复杂先天性心脏病术后循环呼吸衰竭的治疗中是一种有效的机械辅助方法，同时可以作为心脏移植患儿等待供体期间的过渡桥梁。手术畸形纠治满意、尽早对心肺衰竭的患儿使用ECMO支持、避免重要脏器的不可逆损伤依然是ECMO成功的关键。

Objective To summarize and analyse the files of consecutive 12 pediatric ECMO performed in Fuwai Cardiovascular Hospital retrospectively. Methods We reviewed the clinical protocols of 12 pediatric ECMO before and after cardiac surgery from Dec. 2004 to Dec. 2005 in our hospital. ECMO equipments of Medtronic Ltd were utilized to every patient and the inter-surface of the system was covered completely by heparin-coating technique. All patients applied veno-artery ECMO and active clotting time （ACT） maintained between 146-258sec and heparin usage dose was 5-20 U/（kg·h）. Mean blood flow was 40-220 ml/（kg· min） during ECMO assistant period. Results The shortest ECMO time was 55h and longest 266h and mean time 120h. ECMO were weaned off successfully in 9 patients （75 % ） and 6 of them （67 % ） were survival to discharged and 3 of them were died of post-operation complications. Three patients could not been weaned off ECMO. Total survival discharge rate was 50 % （6/12） in this cohort study. Lactic acid concentration of artery blood before ECMO in survived patients was significantly lower than that of dead patients （P = 0.022）. Weights between the survival and the dead also had statistic difference （P = 0.019）. Conclusions ECMO is an effective mechanical assistant therapy for cardiac and pulmonary failure patients after cardiac surgery with pediatric complicated congenital heart disease and ECMO can be used as a bridge for heart transplantation to those severe end-stage heart disorder in children. Perfect correction of abnormality and earlier usage of ECMO for cardiac and respiratory failure patients and avoiding the main organs from un-recovery trauma are still the key of success of ECMO .