ECMO在儿童心脏移植中的应用

Application of ECMO in pediatric heart transplantation

体外膜肺氧合(ECMO)可将人体内静脉血液引流至体外,在人工环境下完成红细胞氧合后再重新输入人体,在心肺功能严重不全患者中替心肺完成气体交换及全身血液灌注,在心脏移植领域也发挥着重要的作用。除心脏移植术后循环支持治疗之外,对于术前存在呼吸循环衰竭的患者也可使用ECMO延长心脏移植的等待时间,并与心脏移植手术桥接。然而,目前ECMO在儿童心脏移植中的应用,仍存在围手术期病死率较高、治疗时机难以选择等关键问题。本文就ECMO在儿童心脏移植中应用的发展历史,儿童心脏移植术前、术后ECMO的使用情况,儿童使用ECMO相关并发症,心室辅助装置(VAD)在儿童心脏移植中的应用现状进行简要综述,以期为促进ECMO在儿童心脏移植中的应用提供参考。

Extracorporeal membrane oxygenation(ECMO)could pump the blood from human veins to the outside of the body,oxygenate the red blood cells in an artificial environment and then return them back into the body.ECMO could replace the heart and lungs to complete gas exchange and systemic blood perfusion in patients with severe cardiopulmonary insufficiency,which also plays an important role in the field of heart transplantation.Besides circulatory support treatment after heart transplantation,ECMO may also be used to prolong the waiting time for heart transplantation in patients with respiratory and circulatory failure before operation,as a bridging therapy for heart transplantation.However,at present,the application of ECMO in pediatric heart transplantation still exist challenges,such as high perioperative mortality and difficulty in determining the timing of treatment,etc.In this article,the development history of ECMO application in pediatric heart transplantation,use of ECMO before and after pediatric heart transplantation,ECMOrelated complications in children,and application of ventricular assist device(VAD)in pediatric heart transplantation were briefly reviewed,aiming to provide reference for promoting the application of ECMO in pediatric heart transplantation.