Gill Brijesh S, Neville Holly L, Khan Amir M, Cox Charles S, Lally Kevin P
Department of Surgery and Pediatrics, The University of Texas-Houston Medical School, Houston, Texas, USA.
J Pediatr Surg. 2002 Jan;37(1):7-10. doi: 10.1053/jpsu.2002.29417.
BACKGROUND/PURPOSE: Severe meconium aspiration syndrome (MAS) is a frequent indication for extracorporeal membrane oxygenation (ECMO). Trials of less invasive cardiopulmonary support may result in fewer infants treated with ECMO but could delay institution of ECMO. The authors hypothesized that those infants with severe MAS who are treated with ECMO early will have a lower mortality rate and a shorter hospital course than those who receive delayed ECMO.
A retrospective review of all patients with MAS in the national extracorporeal life support (ELSO) registry for the decade 1989 through 1998 was performed. Data from the ELSO registry were examined for demographics, clinical parameters, and treatment course. Patients were divided into 3 groups based on the time from birth to institution of ECMO: group 1, 0 to 23 hours; group 2, 24 to 96 hours; and group 3, greater than 96 hours. These groups were compared for survival, duration of extracorporeal support, and duration of ventilatory support after ECMO. Statistical relevance was determined by analysis of variance (ANOVA) and Tukey's post-hoc test.
A total of 3,235 of 4,002 patients with MAS had complete information on duration of mechanical ventilation. Overall mortality rate was 5.8%. The mortality rate in group 1 (n = 1,266) was 4.8%, group 2 (n = 1,568) 6.0%, and group 3 (n = 401) 7.7%. An increased time to ECMO was associated with a significant increase in mortality rate (P <.05). This also was associated with significant increases in the length of the ECMO run (157 +/- 4 v 130 +/- 2 hours, P =.02) and duration of post-ECMO ventilation (157 +/- 17 v 118 +/- 3 hours; P <.001). Those patients in groups 1 and 2 who did not respond to a trial of high-frequency oscillatory ventilation had significantly longer ECMO runs (129 +/- 2 v 113 +/- 1 hours; P =.001) and longer post-ECMO ventilator courses (137 +/- 2 v 114 +/- 1 hours; P =.002) than those who did not.
Delay in institution of ECMO for MAS results in prolonged ECMO and need for post-ECMO ventilation. Consideration should be given to instituting ECMO earlier in patients with severe MAS.
背景/目的：严重胎粪吸入综合征（MAS）是体外膜肺氧合（ECMO）的常见适应证。侵入性较小的心肺支持试验可能会减少接受ECMO治疗的婴儿数量，但可能会延迟ECMO的应用。作者推测，与延迟接受ECMO治疗的婴儿相比，早期接受ECMO治疗的严重MAS婴儿死亡率更低，住院时间更短。
对1989年至1998年这十年间国家体外生命支持（ELSO）登记处所有MAS患者进行回顾性研究。检查ELSO登记处的数据，了解人口统计学、临床参数和治疗过程。根据从出生到开始ECMO的时间将患者分为3组：第1组，0至23小时；第2组，24至96小时；第3组，大于96小时。比较这几组的生存率、体外支持时间和ECMO后的通气支持时间。通过方差分析（ANOVA）和Tukey事后检验确定统计学相关性。
4002例MAS患者中有3235例有机械通气时间的完整信息。总体死亡率为5.8%。第1组（n = 1266）的死亡率为4.8%，第2组（n = 1568）为6.0%，第3组（n = 401）为7.7%。开始ECMO的时间延长与死亡率显著增加相关（P <.05）。这也与ECMO运行时间显著增加（157±4对130±2小时，P =.02）和ECMO后通气时间延长（157±17对118±3小时；P <.001）相关。第1组和第2组中对高频振荡通气试验无反应的患者，其ECMO运行时间（129±2对113±1小时；P =.001）和ECMO后通气时间（137±2对114±1小时；P =.002）显著长于有反应的患者。
MAS患者延迟应用ECMO会导致ECMO时间延长和ECMO后需要通气。对于严重MAS患者，应考虑更早应用ECMO。
