体外膜肺氧合技术治疗新生儿呼吸衰竭的应用进展

Application of extracorporeal membrane oxygenation in the treatment of neonatal respiratory failure

体外膜肺氧合技术是一种用于治疗新生儿严重呼吸衰竭的重要方法,这种呼吸衰竭往往对高频通气、肺表面活性剂替代、一氧化氮吸入等常规治疗方法无效.其基本原理是将血液从患儿体内引流出,泵入膜氧合器(人工肺)中,经氧合并清除二氧化碳后再灌注到患儿体内.大量国内外的新生儿临床试验已经证实体外膜肺氧合技术治疗呼吸衰竭的有效性和较好的远期结局,但在国内仍处于应用初期阶段.该文就体外膜肺氧合技术的发展、适应证和禁忌证、管理、并发症、院间转运及存活儿长期生活质量的评估等作一综述.

Extracorporeal membrane oxygenation is an important treatment for neonatal cardiopulmonary failure,which is often unresponsive to conventional treatments such as high-frequency ventilation,surfactant replacement,and inhaled nitric oxide.The basic principle is to drain blood from the patient′s body,pump it into a membrane oxygenation(artificial lung),where carbon dioxide is removed and oxygen is added,and then flow back to the patient.A large number of domestic and foreign neonatal clinical trials have confirmed the effectiveness and the good long-term outcomes of extracorporeal membrane oxygenation in the treatment of severe respiratory failure,but its application in China is still in the initial stage.This paper reviews the development of extracorporeal membrane oxygenation technology,indications and contraindications,management,complications,inter-hospital transport,and long-term quality of life assessment of the survived children.