先天性心脏病术后婴儿体外膜肺氧合治疗中途更换膜肺系统的临床经验

Clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation in infants after congenital heart disease operation

目的总结体外循环心脏手术后停机困难,转为体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)治疗,辅助期间更换ECMO系统的经验和疗效。方法回顾性分析本院2019年1月至9月6例先天性心脏病患儿体外循环心脏手术后停机困难,行ECMO治疗期间出现膜肺堵塞,并成功更换ECMO系统,观察更换ECMO系统前后的血流动力学及血气变化。结果6例患儿接受VA-ECMO辅助治疗,男3例,女3例,年龄为1~3个月,体重3.0~4.9 kg,ECMO系统更换过程顺利,耗时175~209 s,患儿的血流动力学稳定,ECMO支持时间为134~249 h,在心脏收缩功能得到改善后,均成功撤机,生存出院。结论通过改良ECMO系统更换时液体置换的方式,可以充分地利用原系统内的血液成分,避免了血液有形成分的丢失,根据快速置换的预案处理,并不会增加置换的风险。

Objective To summarize the clinical experience of changing the membranous pulmonary system during extracorporeal membrane oxygenation(ECMO)in infants after congenital heart disease opration with cardiopulmonary bypass.Methods From January to September in 2019,6 cases of congenital heart disease with cardio-pulmonary bypass in our hospital were analyzed retrospectively,whose membrane obstruction occurred during ECMO treatment and replaced successfully.The hemodynamics and blood gas before and after replacement of ECMO system were observed,and the experience was summarized.Results Six patients(3 males and 3 females),aging from 1 to 3 months and weighing from 3.0 to 4.9 kg,were received VA-ECMO adjuvant therapy.The ECMO system replacement process was smooth and took 175-209 s.The hemodynamic of the children was stable.The ECMO support time was 134-249 h.After the improvement of cardiac systolic function,all children were successfully withdrawn and survived.Conclusion The improved method of liquid replacement in ECMO system can make full use of the blood components in the original system and avoid the loss of blood tangible components.According to the plan of rapid replacement,the risk of replacement will not be increased.