儿童先天性心脏病术后心肺复苏对体外膜氧合预后的影响

Effect of postoperative cardiopulmonary resuscitation on the prognosis of extra⁃corporeal membrane oxygenation in children with congenital heart disease

目的通过单中心研究回顾先天性心脏病患儿术后在ICU内接受体外膜氧合(ECMO)辅助的相关资料,探讨心肺复苏(CPR)对ECMO使用及预后的影响。方法回顾性分析了上海儿童医学中心2017年1月至2019年12月期间58例患儿在先天性心脏病纠治术后于ICU接受ECMO治疗的病例资料。根据患儿是否接受CPR,将患儿分为体外心肺复苏(ECPR)组(n=26)与非心肺复苏(NCPR)组(n=32)。分析两组患儿的预后及并发症等区别。结果在ICU内安装ECMO的58例患儿中,成功撤离ECMO为40例(68.97%),出院为31例(53.45%)。行ECPR的26例(44.83%)患儿中,成功撤离ECMO的患儿有14例(53.85%),出院10例(38.46%);NCPR组32例(55.17%)患儿中,撤离ECMO的患儿为26例(81.25%),出院患儿21例(65.63%),两组间的脱机率(P=0.025)与存活率(P=0.039)具有显著差异。ECPR组安装前乳酸值、ECMO中肾衰及消化道出血发生率都显著高于NCPR组(P值分别为0.001,0.030,0.039)。结论先天性心脏病患儿术后行ECPR的患儿脱机率与存活率都低于NCPR患儿,且肾功能衰竭及胃肠道出血等并发症发生率高。

Objective The objective of this study is to assess the effect of cardiopulmonary resuscitation(CPR)on the progno⁃sis of extracorporeal membrane oxygenation(ECMO)in children after cardiac surgery.Methods We retrospectively reviewed the data of 58 children with congenital heart disease(CHD)who received ECMO postoperatively from January 2017 to December 2019 in Shanghai Children's Medical Center.According to whether received CPR before ECMO,the children were divided into the extracorpore⁃al cardiopulmonary resuscitation(ECPR)group and non-CPR(NCPR)group.Results Among the 58 children received ECMO in ICU,40 cases(68.97%)were successfully weaned from ECMO,and 31 cases(53.45%)survived to discharge.Among the 26 chil⁃dren(44.83%)in ECPR group,14(53.85%)were successfully weaned from ECMO,and 10(38.46%)survived to discharge.A⁃mong the 32 children(55.17)in NCPR group,26(81.25%)were weaned from ECMO and 21(65.63%)survived to discharge.There were significant differences in the weaning rate(P=0.025)and survival rate(P=0.039)between the two groups.The lactate value before ECMO,the incidence of renal failure and gastrointestinal bleeding in ECPR group were significantly higher than those in NCPR group(P=0.001,0.030,0.039,respectively).Conclusion The weaning rate and survival rate of children with CHD under⁃went ECPR postoperatively were lower than those in NCPR children,and the incidence of complications such as renal failure and gas⁃trointestinal bleeding was significantly higher in ECPR group.