小儿体外心肺复苏临床结果的回顾性研究

Clinical results of extracorporeal cardiopulmonary resuscitation in children:a single-center retrospective study

目的本文总结单中心小儿体外心肺复苏(ECPR)的临床结果,探讨死亡与并发症的高危因素,以指导临床治疗。方法回顾性分析2015年1月至2018年12月单中心开展小儿ECPR患者(<14岁)的临床资料,一般特征包括性别、年龄、体重、身长、体外膜氧合(ECMO)前血压,以及心肺转流时间、主动脉阻断时间等。比较死亡患儿和存活患儿的脱机率,评估与生存率和并发症相关的危险因素。结果52例患儿接受了ECPR救治,男33例,女19例,平均年龄(15.3±6.4)月,复杂先天性心脏病(先心病)35例,简单先心病13例,非心脏病4例,共有19例(36.5%)患儿成功脱离ECMO,有10例(19.6%)存活至出院。非先心病患儿存活率明显高于复杂先心病患儿(P=0.017),相对于存活患儿,死亡患儿在ECPR插管前的血乳酸值明显升高(OR=3.014,P=0.016)。ECPR患儿并发症中,27例患儿发生肾脏损害并接受了肾脏替代疗法(RRT),11例患儿出现需要处理的出血并发症,3例患儿发生了血栓并发症以及7例患儿存在神经系统损伤。对需要接受RRT治疗的患儿,ECMO持续时间、低动脉血压是患儿接受RRT治疗的高危险因素。结论小儿ECPR前高乳酸、复杂先心病是死亡风险因素;并发症中以肾功能不全为主;ECMO持续时间越长、术前平均动脉压越低,需进行RRT治疗的风险越高。

Objective To summarize the clinical results of a single center pediatric extracorporeal cardiopulmonary resuscitation(ECPR)and to explore the independent risk factors of death and complications,so as to guide the clinical treatment.Methods The clinical data of pediatric patients(<14 years old)who underwent ECPR in our center from January 2015 to December 2018 were retrospectively analyzed.Baseline characteristics included gender,age,weight,length,blood pressure before extracorporeal membrane oxygenation(ECMO),CPB time,aortic cross-clamp(ACC)time etc.We compared the weaning rates between the dead and the survival children and evaluated risk factors associated with mortality rate and complications.Results Among 52 patients underwent ECPR with the average age of(15.3±6.4)months(33 males,19 females),there were 35 cases of complex congenital heart disease(CHD),13 cases of simple CHD and 4 cases of non-heart disease.19 cases(36.5%)were successfully weaned from ECMO and 10 cases(19.6%)survived to discharge.The survival rate of children with non CHD was significantly higher than that of children with complex CHD(P=0.017).Compared with survivors,the lactate levels before ECPR intubation were significantly higher in non-survivors(OR:3.014,95%CI:1.230-7.381,P=0.016).Among the complications of ECPR,27 patients had renal damage and received renal replacement therapy(RRT),11 cases had bleeding complications,3 cases had thrombosis complications and 7 cases had neurological damage.The duration of ECMO and hypotension were independent risk factors for children who received RRT.Conclusion The high lactate level before ECPR and complex CHD were independent risk factors of death.The main complications were renal insufficiency.The longer the ECMO duration and the lower preoperative mean arterial pressure were,the higher the risk of RRT treatment would be.