婴幼儿颈部通路体外膜肺氧合相关性出血并发症分析

Bleeding complications in infants undergoing extracorporeal membrane oxygenation with cervical intubation

目的研究婴幼儿颈部通路体外膜肺氧合(ECMO)所致出血并发症及转归。方法回顾性分析2009年9月至2021年1月期间在中山市人民医院行颈动静脉插管ECMO治疗的21例婴幼儿临床资料。观察ECMO运行期间和撤机后血小板、凝血功能和出血并发症情况。结果ECMO建立后血小板计数明显下降,活化部分促凝血酶原激活时间(APTT)和活化全血凝固时间(ACT)快速升高,差异均有统计学意义(P<0.05)。出血并发症发生率为61.90%(13/21),包括颈部切口出血8例(38.10%)、肺出血7例(33.33%)、消化道出血5例(23.81%)、颅内出血3例(14.29%)、泌尿系统出血2例(9.52%)。出血组死亡率为38.46%(5/13),无出血组死亡率为25.00%(2/8)。结论婴幼儿颈部通路ECMO相关出血并发症较多。颅内出血在上机期间影响患儿生存,但撤机后基本可以恢复正常,无严重后遗症。

Objective To study the complications and outcome of bleeding caused by cervical intubation during extracorporeal membrane oxygenation(ECMO)in infants.Methods A retrospective analysis was carried out of 21 infants treated with common carotid artery-internal jugular vein ECMO from September 2009 to January 2021 in Zhongshan City People’s Hospital.The data of platelet,coagulation and bleeding complications during and after ECMO were observed.Results Platelet was reduced,activated partial thromboplastin time(APTT)and activated clotting time of whole blood(ACT)were statistically increased before and during ECMO(all P<0.05).The incidence of bleeding complications was 61.90%(13/21),including 8 cases(38.10%)of neck incision bleeding,7(33.33%)of pulmonary hemorrhage,5(23.81%)of gastrointestinal bleeding,3(14.29%)of intracranial hemorrhage,and 2(9.52%)of urinary bleeding.The mortality rate in the bleeding group and non-bleeding group was 38.46%(5/13)and 25.00%(2/8).Conclusions Bleeding complications caused by ECMO with cervical intubation is common in infants.Intracranial hemorrhage affects the survival of infants during ECMO,while all of them can return to normal after ECMO.