体外膜肺氧合支持下转运心肺功能衰竭患儿三例

Three transports of children with respiratory or cardiac failure under extracorporeal membrane oxy￣genation support

目的：介绍体外膜肺氧合支持下转运3例心肺功能衰竭儿科患者的经验。方法回顾分析2016年2月至4月陆军总医院附属八一儿童医院ECMO辅助下转运完全性大动脉转位（室间隔完整）合并心功能衰竭新生儿1例（病例1）、重症肺炎合并急性呼吸窘迫综合征1例（病例2）、肾病综合征并发卡氏肺孢子虫肺炎继发急性呼吸窘迫综合征1例（病例3）临床资料。结果病例1在ECMO 辅助下转运时间8 h,ECMO辅助43 h,入院第2天行大动脉调转术,术后延迟关胸,入院后7 d撤离呼吸机,15 d转出监护室；病例2在ECMO辅助下转运时间14 h,入院后第3天撤离ECMO,ECMO辅助45 h,入院后第8天撤离呼吸机,10 d转出监护室；病例3在ECMO辅助下转运时间15 h,ECMO辅助时间32 d,ICU停留时间31 d,最终死于多脏器功能衰竭（肺、肾、消化道、心脏）。结论成熟儿科团队,在ECMO辅助下,转运心肺功能衰竭重症患儿是可行和安全的。

Objective To introduce experience of 3 transports of children with respiratory or cardiac failure under extracorporeal membrane oxygenation（ECMO） support. Methods The clinical data of three patients,neonatal transposition of great arteries/intact ventricular septum with heart failure （ case 1 ） , severe pneumonia complicated with acute respiratory distress syndrome（case 2） and nephrotic syndrome complicat-ed with pneumocystis carinii pneumonia and acute respiratory distress syndrome （ case 3 ） transferred to Bayi Children′s Hospital under ECMO support from February to April 2016,were analyzed retrospectively. Results Case 1 was safely transferred to our hospital after 8-hour ECMO transport with the assistance of 43 hours. Switch operation was finished the next day. The sternum was closed postoperatively in 2 days,ventilation was weaned in 7 days and transferred out of ICU in 15 days. Case 2 was transported to our institution after 8 hours. The patient with 45-hour assistance of the ECMO device had to be ventilatied for 8 days,the stay on ICU was 10 days. The 3rd patient had been treating with the ECMO device 32 days after 15-hour transportion under ECMO support,died of multiple organ failure. Conclusion ECMO support for the critical respiratory or cardiac failure in children can be performed safely and reliably, if the ECMO transport team members received strict training,highly organization and cooperation.