Boykin Arlene R, Quivers Eric S, Wagenhoffer Karen L, Sable Craig A, Chaney Hollis R, Glass Penny, Bahrami K Rais, Short Billie L
Department of Neonatology, Children's National Medical Center, Washington, DC, USA.
Crit Care Med. 2003 Sep;31(9):2380-4. doi: 10.1097/01.CCM.0000084856.00372.CE.
The purpose of this study was to evaluate the long-term cardiopulmonary outcome at ages 10-15 yrs following neonatal extracorporeal membrane oxygenation (ECMO). The specific aims of the study were to assess baseline aerobic capacity, cardiac function, and pulmonary function in neonatal ECMO survivors using graded exercise testing, echocardiography, and pulmonary function tests.
Cohort study.
Exercise and pulmonary function laboratories of a large children's hospital.
Seventeen 10- to 15-yr-old children treated with ECMO as neonates for meconium aspiration syndrome and 17 age-matched healthy controls.
Children were evaluated by use of physical exam, electrocardiogram, echocardiogram, treadmill stress test, and pulmonary function tests.
Average weight, height, and age were similar between the groups. Both pre- and postexercise pulmonary function tests revealed air trapping and mild lower airway obstruction in the ECMO group, compared with mean pulmonary functions in the normal range for the control group. The mean forced expiratory volume in 1 sec, the forced expiratory flow between 25% and 75% of vital capacity, and the ratio between residual volume and total lung capacity were significantly different between the ECMO group and the control group. Although the ECMO group exhibited baseline and postexercise lung function abnormalities, there were no differences in maximal oxygen consumption between the two groups and all subjects reached anaerobic threshold. By regression analysis, the gestational age, duration of oxygen, and exercise score were significantly correlated with baseline lung function, using forced expiratory flow between 25% and 75% of vital capacity as the dependent variable.
Despite abnormalities in baseline and postexercise pulmonary functions, ECMO graduates have similar aerobic capacity to age-matched healthy controls. The most significant factor in predicting long-term pulmonary outcome in ECMO graduates is the duration of oxygen use following decannulation.
本研究旨在评估新生儿体外膜肺氧合（ECMO）治疗后10至15岁时的长期心肺结局。该研究的具体目标是通过分级运动测试、超声心动图和肺功能测试，评估新生儿ECMO幸存者的基线有氧运动能力、心脏功能和肺功能。
队列研究。
一家大型儿童医院的运动和肺功能实验室。
17名10至15岁的儿童，他们在新生儿期因胎粪吸入综合征接受了ECMO治疗，以及17名年龄匹配的健康对照。
通过体格检查、心电图、超声心动图、跑步机压力测试和肺功能测试对儿童进行评估。
两组之间的平均体重、身高和年龄相似。与对照组平均肺功能在正常范围内相比，运动前和运动后肺功能测试均显示ECMO组存在气体潴留和轻度下气道阻塞。ECMO组与对照组之间的1秒用力呼气量、肺活量25%至75%之间的用力呼气流量以及残气量与肺总量之比存在显著差异。尽管ECMO组表现出基线和运动后肺功能异常，但两组之间的最大耗氧量没有差异，所有受试者均达到无氧阈值。通过回归分析，以肺活量25%至75%之间的用力呼气流量作为因变量，胎龄、吸氧时间和运动评分与基线肺功能显著相关。
尽管基线和运动后肺功能存在异常，但ECMO治疗后的儿童与年龄匹配的健康对照具有相似的有氧运动能力。预测ECMO治疗后儿童长期肺结局的最重要因素是拔管后吸氧时间。
