体外膜肺氧合抢救儿童急性暴发性心肌炎12例

Extracorporeal membrane oxygenation for rescuing 12 children with acute fulminant myocarditis

目的 总结体外膜氧合（ECMO）技术抢救儿童急性暴发性心肌炎（AFM）的经验.方法 回顾性总结2009年9月至2015年8月在浙江大学附属儿童医院接受ECMO治疗的12例AFM患儿的临床资料,其中男6例、女6例,中位年龄8.3（0.6,13.0）岁;中位体重33.1（6,61）kg.探讨ECMO对于传统治疗无效的心功能衰竭和（或）恶性心律失常所致心源性休克进而导致组织低灌注患儿的介入时机,分析总结ECMO心肺复苏（ECPR）技术抢救心跳骤停患儿的技术要点.结果 12例AFM患儿ECMO运行时间110（22,240）h.存活10例,死亡2例,8例ECPR患儿6例存活,死亡2例均为ECPR患儿;10例存活患儿并发插管部位出血3例;并发高钠血症、枕顶硬膜下出血1例;并发下肢肌力下降跛行1例;并发声音嘶哑1例;1例ECPR患儿存活并发脑损伤.结论 把握合适的ECMO介入时机,对心跳骤停患者保持有效心脏按压心肺复苏,ECMO技术的熟练应用,均是提高AFM患儿的抢救成功率和生存质量的关键.

Objective To summarize clinical experience of using extracorporeal membrane oxygenation （ECMO） in rescuing children with acute fulminant myocarditis （AFM）.Method Data of 12 children with acute fulminate myocarditis （6 boys and 6 girls,median age 8.3 （0.6,13.0） years,median weight 33.1 （6,61） kg） who were rescued with ECMO in Children＆#39;s Hospital,Zhejiang University from September 2009 to August 2015 were analyzed retrospectively.The analysis focused on the intervene timing of ECMO for the cardiogenic shock and hypoperfusion caused by heart failure and（or） lethal arrhythmia and the essentials of ECMO cardiopulmonary resuscitation （ECPR） for cardiac arrest in pediatric AFM were summarized.Result The median ECMO duration was 110（22,240） h.Ten cases survived and 2 were dead of the total of 12 patients.Six ECPR patients survived and 2 were dead in the total of 8 ECPR patients.The complication of 10 survivors were cannula site bleeding （3 cases）,hypematremia and intracranial hemorrhage （1 case）,limping （1 case）,hoarse voice （1 case）,and cerebral injury （1 case）.Conclusion The key points of improving ECMO rescuing outcome for the AFM children are grasping the ECMO intervene timing and training skilled ECMO team.For ECPR patients,keeping effective chest compressions resuscitation is the key to achieve survival and improve the quality of life.