小儿先天性心脏病体外膜氧合支持的死亡原因分析

Causes of death in the application of extracorporeal membrane oxygenation in pediatric patients with congenital heart diseases

目的总结先天性心脏病体外膜氧合(ECMO)支持患儿的死亡原因,以进一步提高生存率。方法回顾性分析2010年1月至2018年12月实施ECMO支持的先天性心脏病患儿33例。结果33例行ECMO支持的先天性心脏病患儿中,死亡率为54.5%(18/33)。单纯左心功能不全的完全性大动脉转位(TGA)生存率80%(4/5),辅助效果佳;TGA合并冠脉畸形和其他复杂畸形的死亡率100%(7/7);1例左心发育不良存活;术后心源性休克死亡率29%(2/7);复杂先天性心脏病患儿术前严重低氧急诊手术术后转ECMO的死亡率33.3%(1/3),而TGA术前严重低氧血症先采用ECMO支持2例均于术前死亡;2例ECMO期间再次手术干预的患者均存活出院。结论ECMO为先天性心脏病并发难治性心衰的患儿提供了生存机会,心脏功能的可逆程度、心脏畸形的类型以及ECMO时机的把握是先天性心脏病患儿ECMO支持是否成功的主要原因。

Objective The purpose of this study was to review our experience of extracorporeal membrane oxygenation (ECMO) and to analyse the causes of death of ECMO in the application in pediatric patients with congenital heart diseases.Methods We retrospectively reviewed ECMO patients with congenital heart diseases from January 2010 to December 2018.Results Thirty-three children received ECMO from January 2010 to December 2018 with a mortality of 54.5%(18/33).All TGA with coronary artery malformation and other complicated deformities died (7/7) while 20%(1/5) of patients with unsophisticated TGA died .ECMO management of hypoplastic left heart syndrome was more difficult but the patients survived eventually.The mortality of postcardiotomy cardiogeninc shock was 40%(2/5).The mortality of ECMO after emergency surger due to severe hyoxemia was 33.3%(1/3),while two cases of preoperative ECMO support for TGA patients due to severe hyoxemia died.Two patients who underwent re-operation during ECMO support survived.Conclusion ECMO plays a valuable role in children with refractory cardiogenic failure.Potential for recovery,residual cardiac lesions and timing to start ECMO support contribute to the prognosis of children with congenital heart diseases.