非心脏手术后危重症患儿接受动脉－静脉体外膜肺氧合治疗的并发症分析

Complications of critically ill children supported by venoarterial extracorporeal membrane oxygenation

目的 总结危重症儿童动脉－静脉模式体外膜肺氧合（VA－EMCO）治疗过程中的并发症发生情况。方法 回顾性分析，研究对象为2011年12月至2015年12月收住复旦大学附属儿科医院儿科重症监护病房非心脏手术后的25例危重症患儿，所有患儿均开展右侧颈内动静脉切开置管的VA－ECMO治疗。记录患儿在ECMO过程中的并发症发生情况。结果 25例危重症患儿接受ECMO治疗的时间14-567 h，中位153（112，204） h。共有17例（68%）患儿成功撤离ECMO；15例（60%）患儿存活出院。25例危重患儿ECMO治疗期间共发生33次并发症，其中机械并发症9次：氧合器渗漏3次，溶血和水箱故障各2次，管路血栓和泵头破裂各1次；躯体并发症24次：神经系统并发症8次（脑血管梗死2次、惊厥发作2次、颅内出血2次、颈内动静脉结扎后血栓形成及脑萎缩各1次），出血8次（穿刺部位出血4次、ECMO置管部位出血3次、自发血肿1次、另有2次颅内出血已计算在神经系统并发症里），急性肾损伤5例，微循环血栓3次。结论 VA－ECMO的并发症在一定程度及范围内确实存在，主要是机械并发症、神经系统并发症及出血；设备及材质的改良及严格过程管理可减少并发症的发生。

Objective To study the complications occurred in the process of venoarterial extraeorporeal membrane oxygenation （VA-EMCO） in critically ill children. Method To analyze retrospectively 25 children who were admitted to PICU of Children＇s Hospital of Fudan University from December 2011 to December 2015. They were all treated with VA-ECMO with incision and catheterization in right internal carotid artery and jugular vein. Complications were recorded during ECMO process. Result The duration of ECMO treatment was 14 to 567 h （ 153 （112,204） h）. Seventeen cases （68%） withdrew from ECMO successfully and 15 cases （60%） survived to discharge. Thirty-three complications occurred during ECMO treatment. Of which, mechanical complications occurred 9 times, including oxygenator leakage （ n = 3 ）, hemolysis （ n = 2）, water tank failure （ n = 2 ）, pump head rupture （ n = 1 ） and piping thrombosis （ n = 1 ）. Somatic complications appeared 24 times, including neurological complications （ n = 8 ） which included cerebral infarction （ n = 2 ） , convulsions （ n = 2 ） , intracranial hemorrhage （ n = 2 ） , thrombosis after ligation of internal jugular vein （n = 1 ） and cerebral atrophy （n = 1 ）; bleeding complications （ n = 8 ） which included bleeding at puncture sites （ n = 4 ） , ECMO canalized site bleeding （ n = 3 ）, and spontaneous （ n = 1 ）, intracranial hemorrhage or hematoma cases （ n = 2 ） in mechanical complications ; acute kidney injury （ n = 5 ） and microcireulation thrombosis （ n = 3 ）. Conclusion ECMO technique may cause complications, which mainly include neurological, mechanical and clotting complications. Advanced equipments and materials and well-managed teamwork are helpful in decreasing complications.