刘颖悦，洪小杨，周更须，王 辉，王 刚，张晓娟，高海涛，封志纯



体外膜肺氧合在儿童先天性心脏病术后心功能衰竭救治中的应用

刘颖悦，洪小杨，周更须，王 辉，王 刚，张晓娟，高海涛，封志纯

［摘要］：目的 探讨体外膜肺氧合(ECMO)技术在先天性心脏病术后出现心功能衰竭患儿救治中临床应用。方法 回顾性总结2012年6月至2015年9月间,在本院行先心病手术并接受ECMO辅助患儿临床资料。结果 共20例先天性心脏病患儿术后因心功能衰竭接受ECMO支持,年龄2 d～1岁；体重3～10 kg；共有14例撤离ECMO(撤机率70%),存活出院9例(存活率45%),死亡11例,其中6例为心功能无法恢复撤机失败,5例撤机后死于并发症。心功能无法恢复及ECMO支持过程中的并发症是导致此类患儿死亡的主要原因。结论 对于出现严重心功能衰竭的先天性心脏病术后患儿,及时快速进行ECMO支持,提高管理水平减少并发症,能够提高此类患儿存活率。

［关键词］：先天性心脏病；体外膜肺氧合；小儿；心功能衰竭

Application of extracorporeal membrane oxygenation in heart failure after pediatriccardiac surgery

Liu Ying-yue,Hong Xiao-yang,Zhou Geng-xu,Wang Hui,Wang Gang,Zhang Xiao-juan,Gao Hai-tao,Feng Zhi-chun
Affiliated BaYi Children＇s Hospital,General Military Hospital of Beijing PLA,Beijing 100700,China
Corresponding author:Feng Zhi-chun,E-mail:zhjfengzc@ 126.com

［Abstract］：Objective To summarisethe clinical experience withextracorporeal membrane oxygenation in treatment of heart failure after pediatriccardiac surgery.Methods Clinical data of 20 pediatric patients who received ECMO support after cardiac surgery in our centerfrom June 2012 to September 2015 were retrospectively analyzed.Results A total of 20 postoperative children with heart failure received ECMO support aged from 2 days to 1 years old with weight between 3 to 10 kg.There were14(70%)patients who successfully weaned from ECMO and 9(45%) cases survived to discharge.Elevenpatients died.Among them,six cases died of unsuccessful weaning from ECMO and five died of complications.Inability to wean from ECMO support and the complications in the process of treatment had an increased risk of death.Conclusion ECMO couldn provide effective support for congenital heart disease children with cardiac failure after surgery.

［Key words］： Congenital heart disease；Extracorporeal membrane oxygenation；Children；Cardiac failure

体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)技术是体外生命支持的重要组成部分,是在体外循环基础上发展起来的技术。由泵提供动力,通过体外血液气体交换,为各种原因导致的心肺功能衰竭重症患者,暂时性进行心肺支持,为疾病的恢复争取时间窗口。随着高难度、复杂的心脏手术在新生儿及婴幼儿中开展的逐渐增加,ECMO辅助作为一种持续体外生命支持疗法在高危患儿心脏术后的应用也日益增多[1]。19世纪70年代,ECMO技术最早用于急性呼吸窘迫综合征。Baffes等人将ECMO应用于先天性心脏病支持,虽然使用时间短,却为心肺复苏和心脏围手术期应用开了先河[2]。……