体外膜肺支持在新生儿和婴幼儿复杂先天性心脏病术后的应用

Extracorporeal membrane oxygenation for the neonates and infants after correction of complex congenital heart disease

目的 总结分析 1994年 2月至 1999年 4月 ,35例复杂先天性心脏病病儿直视手术后行体外膜肺支持的效果。方法 病儿年龄 1～ 82 0d ,中位数 19d ;体重 2 1～ 14 0kg ,中位数 3 6kg。采用静脉 -动脉转流 ,流量每分钟 10 0ml kg ,ACT 180～ 2 0 0s。结果 体外膜肺支持病例占同期婴幼儿心内直视手术的 3 4 % ,主要指征是术后低心输出量综合征 (42 9% )。支持时间 1～ 15d ,中位数 5d。生存 2 1例(6 0 % ) ;晚期生存率 4 9%。保留原体 -肺循环分流者生存率高于未保留者 (80 %比 0 ,P <0 0 5 )。虽然具有 2个心室病儿有较好的治疗效果 (生存率 6 8% ) ,但合并单心室畸形病儿也有 4 0 %的生存率。

Objective: The purpose of this study is focused on analyzing the results of extracorporeal membrane oxygenation (ECMO) for circulatory support in the infants and neonates after surgical repair of their complex congenital heart anomalies. Methods: From February 1994 to April 1999, 35 neonates and infants, average age 1～820 days (median 19 days), and weight 2 1～14 0 kg (median 3 6 kg), out of 1?020 pediatric cardiac patients (3 4%), with complex congenital heart defects, underwent post cardiotomy support with venoarterial ECMO.Results: The main indications for ECMO support were low cardiac output syndrome (42 9%), cardiac failure (34 3%), and cardiac arrest (11 4%). The mean time on ECMO was 1～15 days (median 5 days). Total hospital survival rate was 60%. With 4 late deaths, the overall survival still reached 49 0%. There was a much better survival result in the patients, whose aorto pulmonary shunt was kept open during ECMO, than those whose shunt was closed (80% vs. 0, P< 0 05). Although there was a better survival rate in two ventricle deformations (68%), ECMO for the single ventricle defects also can achieve a survival rate of 40%. The main causes of early death were renal failure, coagulopathy, etc. 15 cases were followed, and the longest follow up period was three years. 14 cases (93 3%) had a normal quality of life. Conclusion: Based on these results, we recommend early application of ECMO to neonates and infants who require cardiac support following cardiac surgery.