小儿心脏术后体外膜氧合支持预后分析

Prognosis analysis of extracorporeal membrane oxygenation support after cardi⁃ac surgery in children

目的总结小儿心脏术后体外膜氧合(ECMO)的使用趋势及不同适应证下生存情况的变化。方法回顾性分析本中心心胸外科数据库,选择2016年1月至2019年12月先天性心脏病术后进行静脉-动脉ECMO辅助的117例患儿,根据适应证分为三组(心脏术后综合征组、心肺衰竭组及心脏骤停组)。结果心脏术后ECMO死亡率呈逐年下降趋势,2016至2019年间死亡率从75.0%降至46.2%。其中心肺衰竭组死亡率下降最明显,2016至2019年间死亡率从100%降至14.3%。因心脏术后综合征接受ECMO支持的患者年龄大、体外循环时间长、Ⅱ期及以上手术比例高。手术室中安置ECMO、ECMO开始时间及持续时间对死亡率无影响(P>0.05)。死亡组中持续肾替代治疗上机率较高、成功撤机率较低(P<0.05)。结论ECMO在先天性心脏病术后的使用是有效的,但学习曲线较长且不同适应证学习曲线不同。因此,针对不同适应证建立不同的指导方针,提高ECMO后的存活率。

Objective To summarize the use trend and mortality of extracorporeal membrane oxygenation(ECMO) associated with congenital heart disease(CHD). Methods Retrospective cohort study was conducted based on cardiothoracic surgery database of Shanghai Children’s Medical Center. From January 2016 to December 2019, patients with CHD received veno-arterial ECMO assistance after surgery were selected and divided into three groups according to clinical indications: postcardiotomy syndrome group, cardiopulmonary failure group and cardiac arrest group. Results The mortality showed a decreasing trend over the past 4 years, from 75.0% in 2016 to 46.2% in 2019. The decline was most pronounced in cardiopulmonary failure group, which ranged from 100% to 14.3% between 2016 and 2019. Patients who received ECMO support because of postcardiotomy syndrome were older, had longer cardiopulmonary bypass time and a higher proportion of operation stage Ⅱ and above. The location of ECMO, the start time of ECMO, and the duration of ECMO had no effect on mortality(P>0.05). In the death group, the probability of CRRT was higher and the probability of successful evacuation was lower(P<0.05). Conclusion Use of ECMO after open heart surgery is effictive and practicable. However, the learning curve is long and different indications have different learning curves. Therefore, different guidelines should be established for different indications to improve survival after ECMO.