新生儿体外膜肺氧合期间的神经监护和评估

Neurological monitoring and evaluation of neonates during extracorporeal membrane oxygenation

体外膜肺氧合(ECMO)是治疗新生儿严重可逆性呼吸或心脏疾病的最后手段,国内应用逐渐增高。随着医疗管理和外科技术的进步及ECMO治疗经验的积累,患儿总的存活率逐渐增高,但神经系统疾病的并发症及远期不良预后的发生率仍较高。因此,ECMO治疗过程中进行神经功能监护和评估临床价值较大,需要联合应用多种神经监测方法,尽可能减少神经系统损伤及降低远期不良预后的发生率。现就新生儿ECMO治疗中常用的神经监测方法的适应证、优缺点、监测时机和频率、持续监测时间及评估神经发育的价值进行综述。

Extracorporeal membrane oxygenation(ECMO)is the last resort for the severe and reversible respiratory or cardiac diseases in neonates and has been increasingly used in China.With the advancement of medical management and surgical techniques and the accumulation of ECMO treatment experience,the overall survival rate has increased.However,neurological complications and long-term poor outcomes is still common.Therefore,the monitoring and evaluation of neurological functions in the progress of ECMO treatment make sense.The combination of multiple monitoring methods can minimize neurological damage and improve long-term prognosis.In this review,the indications,advantages and disadvantages,timing and frequency,duration and neurodevelopmental outcome evaluation of monitoring techniques commonly used in neonatal ECMO therapy were reviewed.