重症患儿院间体外膜肺氧合转运的临床回顾性分析
|
摘要
目的探讨危重患儿体外膜肺氧合(extracorporeal membrane oxygen,ECMO)转运技术应用的可行性及安全性。方法收集2016年2月至2017年11月八一儿童医院通过儿科ECMO转运网络与302医院、郑州儿童医院、西北妇幼保健院等医院合作完成ECMO转运的15例危重患儿的病例(院外转运组具体病情及带机转运指征由八一儿童医院PICU、儿童心脏科与合作医院的PICU、新生儿科等科室共同确认),与同期完成的38例本院院内ECMO操作病例数据进行对比,分析患儿并发症发生率、存活率等指标,评估ECMO转运对患儿治疗的影响。结果 15例ECMO转运患儿中男性10例,女性5例;心脏支持6例,呼吸支持9例,年龄16 d至12岁;体质量3～47 kg;共有11例成功脱离ECMO,总撤机率73. 3%,存活出院10例,存活率66. 7%;治疗期间出现并发症5例,并发症发生率33. 3%。同期院内ECMO患儿共38例,男性30例,女性8例;循环支持10例,呼吸支持28例;出现并发症12例,发生率31. 6%;26例成功撤机,总撤机率68. 4%,存活出院22例,存活率57. 9%。转运组患儿存活率高于院内支持组,但差异无统计学意义[66. 7%vs 57. 9%,P> 0. 05];两组间并发症发生率差异无统计学意义[33. 3%vs 31. 6%,P> 0. 05],转运距离的增加不构成并发症发生率增高。结论成熟规范的重症患儿ECMO转运技术是安全有效的,较之院内ECMO操作来说不会增加患儿并发症的发生率。
Objective To explore the feasibility and safety of extracorporeal membrane oxygen(ECMO) transport for critically ill children. Methods A total of 15 critically ill children transported on ECMO in Bayi Children 's Hospital cooperating with No. 302 Hospital of PLA,Zhengzhou Children 's Hospital,and Northwest Maternal and Child Health Hospital etc. from February 2016 to November 2017 were collected and analyzed in this study. The children's conditions and transport indications of the out-of-hospital transport group were confirmed by the doctors from the PICU and cardiologic department of our hospital and the PICU and neonatologic departments of the cooperative hospitals. The clinical data of the above 15 children were compared with the 38 pediatric ECMO cases conducted in our hospital during the same period. Results The obtained 15 cases of ECMO transport were 10 males and 5 females,at an age from 16 d to 12 years,and weighted from 3 to 47 kg. Six of them underwent ECMO for cardiac support and the other 9 for respiratory support. Eleven patients were successfully withdrawn from ECMO,with a weaning rate of 73. 3%,and 10 cases survived to discharge with a rate of 66. 7%. Among these patients,5 cases(33. 3%) had got a complication during the treatment. During the same period,the 38 cases undergoing ECMO in the local hospital were 30 males and 8 females,and 10 got cardiac supports and 28 respiratory supports. Among them,complications occurred in 12 cases(31. 6%),and 26 cases(68. 4%) were successfully weaned from ECMO. Finally,22 patients(57. 9%) survived to discharge. The survival rate was higher in the interhospital transport group than the intra-hospital group(66. 7% vs 57. 9%,P > 0. 05). No significant difference was found in the incidence of complications(33. 3% vs 31. 6%,P > 0. 05),indicating the transport distance showed no effect on the incidence. Conclusion The mature and standard ECMO transport is safe and effective for critically ill children, and the operation has no effect on the incidence of complications.
Objective To explore the feasibility and safety of extracorporeal membrane oxygen(ECMO) transport for critically ill children. Methods A total of 15 critically ill children transported on ECMO in Bayi Children 's Hospital cooperating with No. 302 Hospital of PLA,Zhengzhou Children 's Hospital,and Northwest Maternal and Child Health Hospital etc. from February 2016 to November 2017 were collected and analyzed in this study. The children's conditions and transport indications of the out-of-hospital transport group were confirmed by the doctors from the PICU and cardiologic department of our hospital and the PICU and neonatologic departments of the cooperative hospitals. The clinical data of the above 15 children were compared with the 38 pediatric ECMO cases conducted in our hospital during the same period. Results The obtained 15 cases of ECMO transport were 10 males and 5 females,at an age from 16 d to 12 years,and weighted from 3 to 47 kg. Six of them underwent ECMO for cardiac support and the other 9 for respiratory support. Eleven patients were successfully withdrawn from ECMO,with a weaning rate of 73. 3%,and 10 cases survived to discharge with a rate of 66. 7%. Among these patients,5 cases(33. 3%) had got a complication during the treatment. During the same period,the 38 cases undergoing ECMO in the local hospital were 30 males and 8 females,and 10 got cardiac supports and 28 respiratory supports. Among them,complications occurred in 12 cases(31. 6%),and 26 cases(68. 4%) were successfully weaned from ECMO. Finally,22 patients(57. 9%) survived to discharge. The survival rate was higher in the interhospital transport group than the intra-hospital group(66. 7% vs 57. 9%,P > 0. 05). No significant difference was found in the incidence of complications(33. 3% vs 31. 6%,P > 0. 05),indicating the transport distance showed no effect on the incidence. Conclusion The mature and standard ECMO transport is safe and effective for critically ill children, and the operation has no effect on the incidence of complications.
引文
[1] BARTLETT R H,GAZZANIGA A B,JEFFERIES M R,et al.Extracorporeal membrane oxygenation(ECMO)cardiopulmonary support in infancy[J]. Trans Am Soc Artif Intern Organs,1976,22:80-93.
[2] BARTLETT R H,GAZZANIGA A B,HUXTABLE R F,et al.Extracorporeal circulation(ECMO)in neonatal respiratory failure[J]. J Thorac Cardiovasc Surg,1977,74(6):826-833. DOI:10. 1097/00002480-197902500-00092.
[3] RAJAGOPAL S K,ALMOND C S,LAUSSEN P C,et al.Extracorporeal membrane oxygenation for the support of infants,children,and young adults with acute myocarditis:a review of the Extracorporeal Life Support Organization registry[J]. Crit Care Med,2010,38(2):382-387. DOI:10.1097/CCM. 0b013e3181bc8293.
[4]许煊,封志纯,洪小杨,等.体外膜氧合支持治疗成功小儿重症肺炎合并心肺功能衰竭一例[J].中华儿科杂志,2009,47(11):852-855. DOI:10. 3760/cma. j. issn. 0578-1310. 2009. 11. 014.XU X,FENG Z C,HONG X Y,et al. Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia[J]. Chin J Pediatrics,2009,47(11):852-855. DOI:10. 3760/cma. j. issn. 0578-1310. 2009. 11. 014.
[5] HONG X Y,FENG Z C,ZHOU G,et al. Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage[J]. Rev Bras Cir Cardiovasc,2013,28(2):292-295. DOI:10. 5935/1678-9741. 20130041.
[6]刘颖悦,洪小杨,周更须,等.体外膜肺氧合应用于纵隔肿物及右肺切除术一例[J].中国小儿急救医学,2014,21(3):187-188. DOI:10. 3760/cma. j. issn. 1673-4912.2014. 03. 024.LIU Y Y,HONG X Y,ZHOU G X,et al. Application of extracorporeal membrane oxygenation in mediastinal mass and right lung resection[J]. Chin Ped Emerg Med,2014,21(3):187-188. DOI:10. 3760/cma. j. issn. 1673-4912. 2014. 03. 024.
[7]林茹,张晨美,谈林华,等.体外膜肺氧合在儿科危重病急救中的应用[J].中华儿科杂志,2012,50(9):649-652.DOI:10. 3760/cma. j. issn. 0578-1310. 2012. 09. 003.LIN R,ZHANG C M,TAN L H,et al. Emergency use of extracorporeal membrane oxygenation in pediatric critically ill patients[J]. Chin J Ped,2012,50(9):649-652. DOI:10.3760/cma. j. issn. 0578-1310. 2012. 09. 003.
[8] DI NARDO M,MACLAREN G,MARANO M,et al. ECLS in pediatric cardiac patients[J]. Front Pediatr,2016,4:109. DOI:10. 3389/fped. 2016. 00109.
[9] BROMAN L M,FRENCKNER B. Transportation of critically ill patients on extracorporeal membrane oxygenation[J].Front Pediatr, 2016, 4:63. DOI:10. 3389/fped. 2016.00063.
[10] WAGNER K,SANGOLT G K,RISNES I,et al. Transportation of critically ill patients on extracorporeal membrane oxygenation[J]. Perfusion,2008,23(2):101-106. DOI:10. 1177/0267659108096261.
[11] OLIVER W C. Anticoagulation and coagulation management for ECMO[J]. Semin Cardiothorac Vasc Anesth,2009,13(3):154-175. DOI:10. 1177/1089253209347384.
[12] RAIS-BAHRAMI K,VANMEURS K P. Venoarterial versus venovenous ECMO for neonatal respiratory failure[J]. Semin Perinatol,2014,38(2):71-77. DOI:10. 1053/j. semperi. 2013. 11. 003.
[13] JAKSIC T,HULL M A,MODI B P,et al. A. S. P. E. N. Clinical guidelines:nutrition support of neonates supported with extracorporeal membrane oxygenation[J]. JPEN J Parenter Enteral Nutr,2010,34(3):247-253. DOI:10. 1177/0148607110369225.
[14] COMBES A,LEPRINCE P,LUYT C E,et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock[J]. Critical Care Med,2008,36(5):1404-1411.DOI:10. 1097/ccm. 0b013e31816f7cf7.
[2] BARTLETT R H,GAZZANIGA A B,HUXTABLE R F,et al.Extracorporeal circulation(ECMO)in neonatal respiratory failure[J]. J Thorac Cardiovasc Surg,1977,74(6):826-833. DOI:10. 1097/00002480-197902500-00092.
[3] RAJAGOPAL S K,ALMOND C S,LAUSSEN P C,et al.Extracorporeal membrane oxygenation for the support of infants,children,and young adults with acute myocarditis:a review of the Extracorporeal Life Support Organization registry[J]. Crit Care Med,2010,38(2):382-387. DOI:10.1097/CCM. 0b013e3181bc8293.
[4]许煊,封志纯,洪小杨,等.体外膜氧合支持治疗成功小儿重症肺炎合并心肺功能衰竭一例[J].中华儿科杂志,2009,47(11):852-855. DOI:10. 3760/cma. j. issn. 0578-1310. 2009. 11. 014.XU X,FENG Z C,HONG X Y,et al. Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia[J]. Chin J Pediatrics,2009,47(11):852-855. DOI:10. 3760/cma. j. issn. 0578-1310. 2009. 11. 014.
[5] HONG X Y,FENG Z C,ZHOU G,et al. Extracorporeal membrane oxygenation as a support for TGA/IVS with low cardiac output syndrome and pulmonary hemorrhage[J]. Rev Bras Cir Cardiovasc,2013,28(2):292-295. DOI:10. 5935/1678-9741. 20130041.
[6]刘颖悦,洪小杨,周更须,等.体外膜肺氧合应用于纵隔肿物及右肺切除术一例[J].中国小儿急救医学,2014,21(3):187-188. DOI:10. 3760/cma. j. issn. 1673-4912.2014. 03. 024.LIU Y Y,HONG X Y,ZHOU G X,et al. Application of extracorporeal membrane oxygenation in mediastinal mass and right lung resection[J]. Chin Ped Emerg Med,2014,21(3):187-188. DOI:10. 3760/cma. j. issn. 1673-4912. 2014. 03. 024.
[7]林茹,张晨美,谈林华,等.体外膜肺氧合在儿科危重病急救中的应用[J].中华儿科杂志,2012,50(9):649-652.DOI:10. 3760/cma. j. issn. 0578-1310. 2012. 09. 003.LIN R,ZHANG C M,TAN L H,et al. Emergency use of extracorporeal membrane oxygenation in pediatric critically ill patients[J]. Chin J Ped,2012,50(9):649-652. DOI:10.3760/cma. j. issn. 0578-1310. 2012. 09. 003.
[8] DI NARDO M,MACLAREN G,MARANO M,et al. ECLS in pediatric cardiac patients[J]. Front Pediatr,2016,4:109. DOI:10. 3389/fped. 2016. 00109.
[9] BROMAN L M,FRENCKNER B. Transportation of critically ill patients on extracorporeal membrane oxygenation[J].Front Pediatr, 2016, 4:63. DOI:10. 3389/fped. 2016.00063.
[10] WAGNER K,SANGOLT G K,RISNES I,et al. Transportation of critically ill patients on extracorporeal membrane oxygenation[J]. Perfusion,2008,23(2):101-106. DOI:10. 1177/0267659108096261.
[11] OLIVER W C. Anticoagulation and coagulation management for ECMO[J]. Semin Cardiothorac Vasc Anesth,2009,13(3):154-175. DOI:10. 1177/1089253209347384.
[12] RAIS-BAHRAMI K,VANMEURS K P. Venoarterial versus venovenous ECMO for neonatal respiratory failure[J]. Semin Perinatol,2014,38(2):71-77. DOI:10. 1053/j. semperi. 2013. 11. 003.
[13] JAKSIC T,HULL M A,MODI B P,et al. A. S. P. E. N. Clinical guidelines:nutrition support of neonates supported with extracorporeal membrane oxygenation[J]. JPEN J Parenter Enteral Nutr,2010,34(3):247-253. DOI:10. 1177/0148607110369225.
[14] COMBES A,LEPRINCE P,LUYT C E,et al. Outcomes and long-term quality-of-life of patients supported by extracorporeal membrane oxygenation for refractory cardiogenic shock[J]. Critical Care Med,2008,36(5):1404-1411.DOI:10. 1097/ccm. 0b013e31816f7cf7.