小儿心脏术后难治性出血行体外膜氧合的临床经验

The application of extracorporeal membrane oxygenation for pediatric post-cardiotomy refractory hemorrhage

目的总结本院小儿先天性心脏病(CHD)心脏术后难治性出血应用体外膜氧合(ECMO)辅助治疗的临床经验。方法回顾性分析本院2016年4月至2018年11月期间因小儿心脏术后难治性出血应用ECMO辅助治疗的5例患儿,其中男3例,女2例。记录患儿一般资料、ECMO建立前、ECMO期间、ECMO撤机后等相关临床资料,总结心脏术后难治性出血患儿行ECMO管理经验。结果5例患儿在手术间因难治性出血无法维持循环和呼吸功能而行ECMO,均成功脱机,仅1例患儿在撤机2月后因蛋白丢失性肠病死亡,ECMO运行时间88~134 h。结论ECMO是治疗CHD心脏术后难治性出血的有效手段,ECMO建立时机、ECMO期间抗凝管理方案和辅助管理措施是治疗成功的关键。

Objective To summarize the clinical experience of extracorporeal membrane oxygenation(ECMO)for post-cardiotomy refractory hemorrhage in children with congenital heart disease.Methods A retrospective analysis was performed in our hospital from April 2016 to November 2018.Five patients were implemented with ECMO for refractory bleeding after pediatric cardiac surgery,including 3 boys and 2 girls.Demographics,clinical characteristics,complications,and the mortality were collected and analyzed.Results Five patients were weaned from ECMO successfully.Only 1 patient died of protein losing enteropathy 2 months after ECMO withdrawal.The ECMO running time was 88-134 hours.Conclusion ECMO is an effective method for post-cardiotomy refractory hemorrhage.The timing of the establishment of ECMO,anticoagulation management and auxiliary management measures during ECMO are the keys to successful treatment.