儿童体外膜肺氧合术后随访分析

Follow-up of survived children supported by extracorporeal membrane oxygenation

目的 总结颈内动静脉切开置管静脉-动脉体外膜肺氧合（V-A ECMO）术后患儿系统随访情况.方法 回顾性分析201 1年12月至2015年12月复旦大学附属儿科医院重症医学科收住的因原发心肺疾病经常规治疗无效,而采用右侧颈内动静脉切开置管,术后行血管结扎的VA-ECMO存活患儿的定期随访资料,包括神经系统功能、原发病、生长发育、术后生活质量及心理发育等.随访自患儿出院后每半年1次.结果 随访0.5～2.0年的10例患儿中男6例、女4例,发病年龄1 d～12岁.10例患儿随访中5例出现神经系统并发症,包括头颅CT异常3例,脑电图异常3例,智力测定异常2例;检查结果异常患儿中3例病初有缺氧病史,其中2例接受心肺复苏治疗.听性脑干诱发电位（BEAP）检查8例正常.10例患儿原发病均得到较好控制;6例留有不同程度后遗症,包括轻度心律失常1例、残留心脏结构异常2例;肺功能异常3例.原发病造成的后遗症仅限于检查所见.所有患儿头围检测及系统体检无明显异常;血生化、血红蛋白及血气分析正常;仅1例身高及体重低于正常第3百分位.1例疾病初期接受心肺复苏的患儿日常活动有障碍,表现为走路不协调、走路不稳.1例患儿稍有暴躁、不合群.结论 ECMO术后患儿后遗症多由原发病造成,ECMO治疗较安全,后遗症少.

Objective To summarize the follow-up of children treated with venoarterial extracorporeal membrane oxygenation （ECMO） by incision of internal carotid artery-vein.Method This was a retrospective study,10 children in whom the conventional therapy failed,but survived after treatment with ECMO technique through right internal jugular artery-venous incision and ligation after ECMO in pediatric intensive care unit （PICU） of Fudan University were followed up from December 2011 to December 2015.Primary disease situation,neurological development,growth and development,quality of life and personality development were included.All children were followed up once every six months after discharge,and once a year after 2 years.The longest follow-up period was 2 years.Result Of the 10 children 6 were boys and 4 girls,and ranged in age of onset from 1 day to 12 years.Five children had neurological problems,including abnormal brain CT （n =3）,abnormal electroence phalogram （EEG） （n =3）,and mental retardation （n =2）.Three of those children had a history of hypoxia,2 of whom accepted cardiopulmonary resuscitation.Eight children had normal brainstem evoked potential （BEAP） examinations.Primary diseases were all well controlled except for 6 children who had different degrees of sequelae,including mild arrhythmia （n =1）,heart structure abnormality （n =2） and abnormal pulmonary function （n =3）.The sequelae caused by the primary diseases were just embodied in examination.Their head circumference measurement and physical examination showed no obvious abnormalities,and blood biochemical tests,hemoglobin and blood gas analysis were also normal One child＆#39;s height was less than P3.The one who accepted cardiopulmonary resuscitation （CPR） at early stage of primary disease had trouble in daily life,presenting uncoordinated and unstable walking.One child was slightly bad tempered and asocial,and the rest were normal.Conclusion The rest could take care of themselves.The ECMO sequelae of those survived children were mostly caused by primary diseases.ECMO treatment is safe and has less adverse consequences.