中国儿童重症监护病房体外膜肺氧合技术应用现状调查

Surveying the status of extracorporeal membrane oxygenation application in Chinese pediatric intensive ;care unit

目的：了解中国PICU体外膜肺氧合（ ECMO）技术开展及ECMO疗效情况。方法采用问卷调查方式,2015年3月至2015年8月对全国三级甲等医院PICU进行调查。结果共调查了38家儿童医院或综合医院的PICU,其中儿童医院28家,综合医院10家。10家医院的PICU拥有12台ECMO设备；能开展ECMO技术的单位6家,准备开展ECMO技术的单位14家；接受过ECMO培训的医院8家。共有63例患儿在 PICU 内接受非开胸 ECMO 治疗,成功撤离 ECMO 者49例,有效率77.8％；36例存活,存活率57.1％。儿童患者（大于28 d）51例,其中呼吸系统疾病21例,心脏疾病28例,心肺衰竭2例；存活出院31例,存活率60.8％。新生儿患者12例,呼吸系统疾病10例,心脏疾病2例,存活出院5例,存活率41.7％。结论国内儿科领域ECMO技术尚处于起步阶段,且发展不均衡,整体上存活率低于国际水平,今后需要进一步增加ECMO技术在儿科领域应用的临床实践,提高国内危重患儿的救治水平。

Objective To investigate the application of extracorporeal membrane oxygenation （ ECMO） in pediatric intensive care unit（ PICU） in China. Methods Data were collected by questionnaire in PICU of tertiary hospitals,which included children′s hospitals and the pediatric sections of general hospitals from 26 provinces/municipalities/autonomous regions in China from March to August 2015. Results Total 38 hospitals were enrolled, including 28 children hospitals and 10 general hospitals. Six PICU carried out ECMO technology. Fourteen PICU prepared to perform this technology. Nine had ECMO team, and 8 had received ECMO training. Ten PICU had a total of 12 ECMO machines. Sixty-three patients were supported with non-open chest ECMO, 49 （ 77. 8%） of which were decannulated from ECMO successfully, and 36 （57. 1%） survived. Twelve neonates were enrolled,including 10 patients with respiratory failure and 2 with cardiac failure,5 of them survived to discharge. Of 51 pediatric patients received ECMO,28 were supported for cardiac failure,21 for respiratory failure,and 2 for extracorporeal cardiopulmonary resuscitation,31 cases （60. 8%） survived to discharge. Conclusion ECMO technology is still at the initial stage. More efforts are needed to improve the relative equipment,ECMO team and ECMO training in China.