呼吸支持的体外膜氧合技术在儿童重症疾病中的应用

Clinical application of respiratory-supported extracorporeal membrane oxygenation in pediatric critical diseases

目的 总结呼吸支持的体外膜氧合(ECMO)技术在儿童重症疾病中的临床应用经验。方法 回顾本院体外生命支持团队于2017年至2020年11例儿童重症患儿行呼吸支持ECMO治疗的病例,其中单纯性急性呼吸窘迫综合征(ARDS)4例,ARDS合并血液疾病和慢性支气管肺发育不良各3例,假性动脉瘤1例。采用静脉-动脉ECMO模式9例,静脉-静脉ECMO模式2例。结果 11例患者中男6例(54.5%),置管时中位年龄为1.0(0.6,5.0)岁,平均体重(12.4±8.2)kg;平均上机时间为(14.7±8.0)d;套包更换率27.3%,最长套包使用时间为18 d;成功撤机率63.6%,出院存活率54.5%。并发症包括溶血和颅内出血各1例,死亡3例。结论 ECMO用于单纯性ARDS患儿的预后较好,但合并其他系统疾病时预后较差。在ECMO支持下行支气管镜检查和肺泡灌洗,以期缩短患儿病程、促进肺部恢复。

Objective To summarize the experience of clinical application of respiratory-supported extracorporeal membrane oxygenation(ECMO) in pediatric critical diseases.Methods We retrospectively analyzed the data of children who underwent respiratory-supported ECMO from 2017 to 2020.Results A total of 11 children who underwent respiratory-supported ECMO were retrospectively analyzed,including 4 cases of acute respiratory distress syndrome(ARDS),3 cases of ARDS combined with chronic pulmonary bronchial dysplasia,3 cases of ARDS complicated with blood system diseases,and 1 case of pseudoaneurysm.9 children received VA ECMO,and 2 children received VV ECMO.Among these patients,6(54.5%) were male,with a median age of 1.0(0.6,5.0) years and an average weight of(12.4±8.2) kg.The average ECMO time was(14.7±8.0) days.Package replacement rate was 27.3%,and the longest package use time was 18 days.The success rate of withdrawal was 63.6%,and the discharge survival rate was 54.5%.Complications occurred in 1 case of hemolysis,1 case of pseudoaneurysm,and 1 case of intracranial hemorrhage.Conclusion ECMO has a good prognosis in children with simple ARDS,but the prognosis is poor when combined with other systemic diseases.Bronchoscopy and alveolar lavage under the support of ECMO may shorten the course of disease and promote pulmonary recovery in children.