体外膜肺氧合救治危重症新生儿的临床应用

The evaluation of extracorporeal membrane oxygenation in clinical management of critically ill neonates

目的探讨体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)在危重症新生儿救治中的临床效果及安全性.方法回顾性分析2016年11月至2018年9月上海市儿童医院新生儿重症监护室应用ECMO技术救治的危重症新生儿临床资料.ECMO治疗指征为经常规治疗无效且可逆转的呼吸衰竭,模式为静脉-动脉体外膜肺氧合,记录治疗前、治疗后24 h氧合指数、血管活性药物评分、血乳酸等指标,分析新生儿应用ECMO治疗的并发症,应用配对t检验对治疗前后指标进行统计学分析.结果共有5例新生儿进行ECMO治疗,男4例,女1例;原发病为胎粪吸入综合征3例,肺动脉高压2例.ECMO治疗24 h后与治疗前比较氧合指数[(9.5±1.8)比(60.6±19.4)]、血管活性药物评分[(19.5±12.0)分比(204.0±143.8)分]、血乳酸[(2.8±1.5)mmol/L比(9.6±3.6)mmol/L]均明显下降,差异有统计学意义(P<0.05).5例均出现血小板减少,3例合并肾功能不全需联合应用持续肾脏替代治疗,其中1例并发颅内出血;存活3例,死亡2例;存活的3例患儿中2例继发神经系统损伤,需长期随访及康复治疗.结论ECMO技术应用于危重症新生儿治疗效果显著,能挽救部分患儿生命,但存在多种并发症风险.

Objective To study the clinical efficacy and safety of extracorporeal membrane oxygenation(ECMO)in critically ill neonates.Method From November 2016 to September 2018,the clinical data of 5 cases who received ECMO treatment in NICU of our hospital were retrospectively analyzed.The indication of ECMO was reversible respiratory failure irresponsive to conventional therapy.The treatment mode was V-A ECMO.Oxygenation index(OI),vasoactive-inotropic score,blood lactate before and 24 h after ECMO were recorded.Complications of ECMO were also studied.Paired t-test was used to compare the pre and post treatment parameters.Result Among the 5 cases,4 cases were male and 1 case was female.3 cases were diagnosed with meconium aspiration syndrome,2 cases pulmonary hypertension.OI[(9.5±1.8)vs.(60.6±19.4)],vasoactive-inotropic score[(19.5±12.0)points vs.(204.0±143.8)points]and blood lactate[(2.8±1.5)mmol/L vs.(9.6±3.6)mmol/L]were all significantly decreased at 24 h after ECMO treatment(P<0.05).During follow-up,3 cases survived,2 cases died.All the 5 cases showed thrombocytopenia,3 cases developed renal failure and received continuous renal replacement therapy,1 case got intracranial hemorrhage.2 of the 3 survived cases developed neurological impairment and need long term follow-up and rehabilitation therapy.Conclusion ECMO treatment has remarkable effects on critically ill neonates and may actually save lives,but the risk of complications are quite high.