Jaillard S, Pierrat V, Truffert P, Métois D, Riou Y, Wurtz A, Lequien P, Storme L
Department of Thoracic Surgery, A. Calmette Hospital, Centre Hospitalier Régional et Universitaire de Lille, Bd. du Professeur Leclercq, 59037 cedex, Lille, France.
Eur J Cardiothorac Surg. 2000 Sep;18(3):328-33. doi: 10.1016/s1010-7940(00)00514-5.
Extracorporeal membrane oxygenation (ECMO) is a technique of extracorporeal oxygenation used in newborn infants with refractory hypoxemia after failure of maximal conventional medical management, when mortality risk is higher than 80%. We retrospectively reviewed all the neonates treated by ECMO between October 1991 and September 1997 in our newborn intensive care unit.
Fifty-seven patients were treated with ECMO for severe respiratory failure: congenital diaphragmatic hernia (CDH) (n=23), neonatal sepsis (NS) (n=14), meconium aspiration syndrome (MAS) (n=12), and others (n=8). Mean gestational age and birth weight were 38+/-2 weeks and 3200+/-500 g, respectively. Oxygenation index was 61+/-8. Both venovenous (n=28) or venoarterial ECMO (n=29) were used. The mean time at ECMO initiation was 47 h (range 8 h-2 months). The mean duration was 134+/-68 h. In each case of VA ECMO, carotid reconstruction was performed. Survival at 2 years was 40/57 (70%) (CDH 12/23 (52%), NS 11/14 (79%), MAS 12/12 (100%), others 5/8). Follow-up at 2 years was available in 36 survivors.
Neurodevelopmental outcome was not related to the initial diagnosis: normal neurologic development (n=30), cerebral palsy (n=5), and neurologic developmental delay (n=1). Two patients remained oxygen dependant at 2 years, and four required surgical treatment for severe gastroesophageal reflux. Respiratory and digestive sequelae were more frequent in the CDH group (P<0.01). Patency and flow of the repaired carotid artery was assessed in 20 infants at 1 year of age using Doppler ultrasonography: normal (n=10), <50% stenosis (n=9), and >50% stenosis (n=1).
ECMO increased survival of newborn infants with refractory hypoxemia. However, higher a survival rate and lower morbidity were found in non-CDH infants than in congenital diaphragmatic hernia.
体外膜肺氧合（ECMO）是一种体外氧合技术，用于经最大程度的传统药物治疗失败后仍患有难治性低氧血症的新生儿，此时其死亡风险高于80%。我们回顾性分析了1991年10月至1997年9月在我们新生儿重症监护病房接受ECMO治疗的所有新生儿。
57例因严重呼吸衰竭接受ECMO治疗的患者：先天性膈疝（CDH）（n = 23）、新生儿败血症（NS）（n = 14）、胎粪吸入综合征（MAS）（n = 12）及其他（n = 8）。平均胎龄和出生体重分别为38±2周和3200±500 g。氧合指数为61±8。采用静脉-静脉（n = 28）或静脉-动脉ECMO（n = 29）。开始ECMO的平均时间为47小时（范围8小时至2个月）。平均持续时间为134±68小时。在每例VA ECMO病例中，均进行了颈动脉重建。2岁时的生存率为40/57（70%）（CDH 12/23（52%），NS 11/14（79%），MAS 12/12（100%），其他5/8）。36名幸存者有2年的随访资料。
神经发育结局与初始诊断无关：神经发育正常（n = 30）、脑瘫（n = 5）和神经发育延迟（n = 1）。2名患者在2岁时仍依赖吸氧，4名患者因严重胃食管反流需要手术治疗。CDH组呼吸和消化后遗症更为常见（P<0.01）。在1岁时，使用多普勒超声对20例婴儿修复后的颈动脉通畅情况和血流进行评估：正常（n = 10）、狭窄<50%（n = 9）和狭窄>50%（n = 1）。
ECMO提高了难治性低氧血症新生儿的生存率。然而，非CDH婴儿的生存率更高，发病率更低，高于先天性膈疝婴儿。
