中国儿童体外膜肺氧合技术应用现状调查

The application of extracorporeal membrane oxygenation in children in China

目的了解中国儿童体外膜肺氧合（ECMO）技术开展情况及治疗结果。方法采用问卷调查的方式，对全国2017年6月30日之前在18岁以下儿童中ECMO使用情况进行调查。调查中将患者分为两个年龄段：新生儿和儿童；安装ECMO的原因包括心脏原因、呼吸原因和心肺复苏。问卷中各医院按不同年龄段、不同安装原因填写安装例数、撤离例数和成功出院例数，并了解各医院常规参加ECMO管理的临床科室数量。结果共回收43家三级医院所填写的问卷，其中开展儿童（含新生儿）ECMO技术的医院为30家，包括综合医院14家、心胸专科医院5家、儿童医院和妇儿医院11家。最早开展儿童ECMO技术的时间是2004年。至调查截止日，共开展儿童（含新生儿）ECMO共800例，其中儿童数量658例，明显多于新生儿的142例。儿童因心脏原因开展453例，撤离287例（63.4%），出院215例（47.5%）；儿童因呼吸原因开展79例，撤离47例（59.5%），出院36例（45.6%）；儿童因心肺复苏开展126例，撤离62例（49.2%），出院48例（38.1%）。新生儿因心脏原因开展79例，撤离39例（49.4%），出院26例（32.9%）；新生儿因呼吸原因开展40例，撤离26例（65.0%），出院21例（52.5%）；新生儿因心肺复苏开展23例，撤离10例（43.5%），出院6例（26.1%）。开展ECMO技术的30家医院中，常规参与ECMO的临床科室为（4.03±1.87）个。结论国内儿童ECMO技术开展虽晚，但已经有一定的病例数积累，虽然临床结果同国际水平仍有一定的差距，但各医院已初步形成ECMO团队。

ObjectiveTo investigate the application of extracorporeal membrane oxygenation （ECMO） in pediatrics in China as well as the outcomes. MethodsData was conducted by questionnaire to investigate the use of ECMO in children under the age of 18 in China by June 30, 2017. All patients were divided into two age groups： pediatric patients （29 d-18 y） and neonates （1-28 d）; Also by the causes of ECMO treating including cardiac, respiratory and extracorporeal cardiopulmonary resuscitation （ECPR）. The form included the numbers of ECMO cases, weaned and discharged cases, according to the different ages and causes. In addition, the departments that routinely participate in ECMO management were acquired. ResultsTotally 43 tertiary hospitals were enrolled, of which 30 have implemented ECMO for the children patients （comprising pediatrics and neonates）, including 14 general hospitals, 5 cardiothoracic specialty hospitals and 11 children′s or women and children′s hospitals. ECMO for pediatrics and neonates was firstly carried out at China's Mainland in 2004. To the deadline of investigation, 800 patients were supported with ECMO, among which 658 were pediatrics, much more than 142 of neonates. As to pediatrics, 453 were supported with ECMO for cardiac indications with 287 （63.4%） weaned off and 215 （47.5%） survived to discharge; for respiratory causes, 79 cases were registered with 47 （59.5%） weaned off and 36 （45.6%） discharged; for ECPR, 126 were enrolled with 62 （49.2%） successfully weaned off and 48 （38.1%） discharged. In contrast, neonatal patients undergoing cardiac ECMO contained 79 cases, with 39 （49.4%） weaned off and 26 （32.9%） discharged; due to respiratory causes, 40 neonates were included, with 26 （65.0%） weaned off and 21 （52.5%） discharged; 23 neonatal patients consisted of ECPR cause and 10 （43.5%） of them successfully weaned off, but only 6 （26.1%） finally survived. Among the 30 hospitals conducted ECMO for pediatrics and neonates, the average number of departments for ECMO management is 4.03±1.87.ConclusionsAlthough ECMO used for children in China's Mainland is relatively late, a certain number of cases have been accumulated, and there is still a gap compared with the international standard. Meanwhile, each hospital has preliminarily built up its own ECMO team.