体外膜氧合在肝移植术后儿童重度急性呼吸窘迫综合征中的应用

Application of extracorporeal membrane oxygenation for severe acute respiratory distress syndrome after children liver transplantation

目的探讨体外膜氧合(ECMO)在肝移植术后重度急性呼吸窘迫综合征(ARDS)儿童受者的应用。方法回顾性分析天津市第一中心医院接受ECMO支持的2例儿童肝移植受者术后重度ARDS的临床资料,其中1例疑诊卡氏肺孢子菌肺炎,另1例确诊卡氏肺孢子菌肺炎。结果2例儿童受者均采用静脉-动脉(V-A)ECMO模式,ECMO开始前的氧饱和度指数(OSI)分别为31.8和23.9。2例分别在ECMO支持219 h和168 h后成功撤除ECMO;分别在有创机械通气342 h和232 h后撤除呼吸机;ICU停留时间分别为31 d和18 d;住院时间分别为57 d和33 d。2例儿童肝移植受者ECMO支持期间移植肝功能稳定,无新发脏器功能不全,无可致命并发症发生。结论ECMO是儿童肝移植受者术后重度ADRS的一种有潜力的治疗手段,ECMO治疗相关并发症的评估及管理有待进一步研究。

Objective To explore the application of extracorporeal membrane oxygenation(ECMO)for severe acute respiratory distress syndrome(ARDS)in children after liver transplantation.Methods The clinical data were retrospectively analyzed for two ECMO-supported children with severe ARDS after liver transplantation.There were suspected pneumocystis carinii pneumonia(n=1)and identified pneumocystis carinii pneumonia(n=1).Results Veno-arterial ECMO(VA-ECMO)was performed and oxygen saturation index(OSI)before an initiation of ECMO was 31.8 and 23.9 respectively.Both were successfully separated from ECMO after 219 h and 168 h support respectively,and both were weaned from ventilator after 342 h and 232 h invasive mechanical ventilation respectively.The length of ICU stay was 31 and 18 days and the length of hospital stay 57 and 33 days respectively.During ECMO support,liver function remained stable and there was no new onset of organ dysfunction or life-threatening complications.Conclusions ECMO is a potential therapy for children with severe ADRS after liver transplantation and the assessment and management of complications with ECMO support should be further studied.