体外膜氧合辅助支持治疗儿童急性爆发性心肌炎

Extracorporeal membrane oxygenation support in three children with acute fulminant myocarditis

目的观察体外膜氧合(ECMO)在治疗儿童急性爆发性心肌炎中的临床作用。方法回顾性分析2013年7月至2018年6月间,经山东省立医院心脏大血管外科ECMO辅助治疗的3例儿童急性爆发性心肌炎患者的临床资料。结果3例儿童患者均表现为难治性心源性休克和存在恶性心律失常,1例合并心跳骤停且药物治疗效果不佳。在静脉-动脉(V-A)ECMO过程中,患者血流动力学、心脏收缩功能先后得到改善,心肌损伤标志物、脑利钠肽等指标依次下降。经ECMO辅助120~164h后,3例均成功撤机,生存出院,出院后恢复正常生活和学习。并发症为1例股动脉插管位渗血,1例股部切口淋巴漏和1例ECMO早期出现心肌抑制。结论V-AECMO有助于降低儿童爆发性心肌炎患者早期病死率,同时改善患者长期预后,可作为一线治疗措施实施。

Objective To investigate the clinical effects of extracorporeal membrane oxygenation (ECMO) in the treatment of acute fulminant myocarditis in children. Methods We retrospectively analyzed the clinical data of 3 children with acute fulminant myocarditis in Shandong Provincial Hospital between July 2013 and June 2018. Results All the three cases manifested with refractory cardiogenic shock and malignant arrhythmia. One of them suffered from cardiac arrest and had unfavorable response to medication. During ECMO support, their hemodynamics and cardiac systolic function improved, and the biomarkers of myocardial damage and heart failure decreased accordingly. After 120-164 hours of ECMO support, all the 3 children successfully weaned from ECMO, and survived to hospital discharge. Conclusion VA-ECMO can reduce the early mortality of children with acute fulminant myocarditis and improve their long-term prognosis.