右侧颈部切开置管建立体外膜肺氧合救治危重患儿的临床效果分析

Clinical Effect of the Right Neck Incision and Catheterization to Establish Extracorporeal Membrane Oxygenation in the Treatment of Critically Ill Children

目的总结分析右侧颈部切开置管建立体外膜肺氧合(ECMO)救治危重患儿的临床效果。方法以2017年3月至2020年9月河南省儿童医院ECMO团队经右侧颈部切开置管建立体外膜肺氧合辅助治疗的危重患儿作为研究对象,收集临床资料。分析其上机指征、原发疾病种类、年龄、性别、体质量、置管时间、运行时间、撤机率、生存率、并发症等情况。结果共收集40例病例,男24例,女16例,新生儿14例,29 d~5岁26例,原发疾病包括:呼吸窘迫综合征13例,暴发性心肌炎12例,胎粪吸入综合征9例,中毒4例,其他2例。患儿的年龄为1~1783 d,中位年龄为301 d;体质量为2.6~15.8 kg,中位体质量7.7 kg;置管时长20~47 min,中位时长32 min,运行时长6.5~360 h,中位时长118 h。其中11例在体外心肺复苏术(ECPR)下置管,外出转运9例。成功撤机27例,撤机成功率67.50%,出院成活24例,成活率60.00%。并发症:置管深度不合适,需调整3例;置管位置切口出血1例;损伤颈外静脉1例,给予血管修复后好转;切口感染2例。结论右侧颈部切开,颈内静脉-颈总动脉置管,能够快速建立有效的(V-A)ECMO通路,为年龄小、体质量轻的危重患儿提供救治机会,但是认真、熟练、精细的操作和ECMO团队的协作同样是必不可少的。

Objective To summarize and analyze the clinical effect of extracorporeal membrane oxygenation(ECMO)in the treatment of critically ill children with the right neck incision and catheterization.Methods Critically ill children who received an extracorporeal membrane oxygenation adjuvant treatment through the right neck incision established by the ECMO team of Henan children’s Hospital were selected as the research objects from March 2017 to September 2020.Clinical data of the children were collected.Type of primary disease,age,gender,weight,cannulation time,running time,weaning rate,survival rate,complications were analyzed.Results A total of 40 cases were collected,including 24 males,16 females,14 newborns,and 26 children(29 days to 5 years old).The primary diseases included 13 cases of respiratory distress syndrome,12 cases of fulminant myocarditis,9 cases of meconium aspiration syndrome,4 cases of poisoning,and the other 2 cases.The age of the children were 1-1783 days.The median age was 301 days.The weight was 2.6-15.8 kg.The median weight was 7.7 kg.The length of catheterization was 20-47 minutes.The median length was 32 minutes.The running time was 6.5-360 hours.The median time was 118.Among them,11 cases underwent extracorporeal cardiopulmonary resuscitation(ECPR),and 9 cases were transported out.There were 27 cases of successful off-line,and the success rate of off-line was 67.50%.Twenty-four cases were discharged from hospital,and the survival rate was 60.00%.Complications:the depth of the catheter was not suitable,and 3 cases needed to be adjusted.There was 1 case of bleeding from the incision of the catheter position.There was 1 case of injury to the external jugular vein,which improved after vascular repair.There were 2 cases of wound infection.Conclusion The right neck incision and the internal jugular vein-common carotid artery catheterization can quickly establish an effective(V-A)ECMO access,and provide treatment opportunities for young and light-weight critically ill children.But careful and skilled operations and ECMO team collaboration are also essential.