体外膜肺氧合在儿童急性呼吸窘迫综合征中的应用

Clinical application of extracorporeal membrane oxygenation in pediatric acute respiratory distress syndrome

急性呼吸窘迫综合征(acute respiratory distress syndrom, ARDS)是临床常见的急危重症,发生率及病死率较高,是重症患儿入住儿童重症监护病房及住院患儿的主要死亡原因。体外膜肺氧合(extracorporeal membrane oxygenation, ECMO)部分或全部替代患儿心肺功能,可对传统治疗无效的严重心肺衰竭患儿提供较长时间心肺支持。目前,对儿童ARDS的ECMO介入时机和模式选择等方面的临床应用仍存在较多争议。较多成人临床实践推荐将静脉-静脉ECMO(VV-ECMO)模式作为ARDS的首选方案。近年来,ECMO技术有了较大的进步,ECMO临床应用对改善重度肺内外源性ARDS的预后可能有一定作用。

Acute respiratory distress syndrome(ARDS) is a common clinical critical illness, and the incidence and mortality are still high. ARDS causes high pediatric intensive care unit admissions and is the main cause of death. Extracorporeal membrane oxygenation(ECMO)can partially or completely replace the cardiopulmonary function in children, and can provide cardiopulmonary support for children with severe cardiopulmonary failure for a long time.At present, the timing and mode selection of ECMO intervention in children with ARDS are still controversial.In many adult clinical practices, VV-ECMO model is recommended as the first choice for ARDS.In recent years, ECMO technology has made great progress.ECMO may play a role in improving the prognosis of severe intrapulmonary and extrapulmonary ARDS.