Amigoni Angela, Pettenazzo Andrea, Biban Paolo, Suppiej Agnese, Freato Federica, Zaramella Patrizia, Zacchello Franco
Department of Paediatrics, University of Padua, Via Giustiniani 3, 35128 Padua, Italy.
Pediatr Neurol. 2005 Mar;32(3):173-9. doi: 10.1016/j.pediatrneurol.2004.10.002.
This report presents the long-term (36 months) neurologic outcome in 12 neonates and 9 children who survived after extracorporeal membrane oxygenation and attempts to identify its prognostic indicators through a prospective study in the pediatric intensive care unit of a university hospital. Outcome assessment, neurodevelopmental tests, electroencephalogram, auditory evoked potentials, visual evoked potentials, and somatosensory evoked potentials, cerebral sonography, or cerebral tomography were evaluated at the end of bypass and at 6, 12, 24, and 36 months after extracorporeal membrane oxygenation. "Before extracorporeal membrane oxygenation" variables (oxygenation index, pH, oxygen arterial partial pressure) and "during extracorporeal membrane oxygenation" variables (pH, oxygen arterial partial pressure, duration of bypass, clotting activated time, electroencephalogram) were also analyzed. A negative neurologic outcome (Glasgow Outcome Score different from "good recovery" or neurodevelopmental score less than 70) 12 months after extracorporeal membrane oxygenation was documented in 8.3% of neonates and in 30% of children who survived. There was no further change in subsequent evaluations (24 and 36 months follow-up). The most abnormal electroencephalogram during extracorporeal membrane oxygenation, the first electroencephalogram, neuroimaging score, and somatosensory evoked potentials after extracorporeal membrane oxygenation treatment were associated with negative neurologic outcome. The study documented that neonates and children treated with extracorporeal membrane oxygenation require long-term follow-up; electroencephalogram, neuroimaging score, and somatosensory evoked potentials have prognostic value for abnormal neurologic outcome.
本报告呈现了12例新生儿和9例儿童在接受体外膜肺氧合治疗后存活的长期（36个月）神经学转归情况，并试图通过在一所大学医院的儿科重症监护病房进行的前瞻性研究来确定其预后指标。在体外膜肺氧合结束时以及体外膜肺氧合后6个月、12个月、24个月和36个月，对转归评估、神经发育测试、脑电图、听觉诱发电位、视觉诱发电位、体感诱发电位、脑部超声或脑部断层扫描进行了评估。还分析了“体外膜肺氧合前”变量（氧合指数、pH值、动脉血氧分压）和“体外膜肺氧合期间”变量（pH值、动脉血氧分压、体外循环持续时间、活化凝血时间、脑电图）。体外膜肺氧合后12个月，8.3%的新生儿和30%存活的儿童出现了不良神经学转归（格拉斯哥预后评分不同于“良好恢复”或神经发育评分低于70）。在后续评估（24个月和36个月随访）中没有进一步变化。体外膜肺氧合期间最异常的脑电图、首次脑电图、神经影像学评分以及体外膜肺氧合治疗后的体感诱发电位与不良神经学转归相关。该研究表明，接受体外膜肺氧合治疗的新生儿和儿童需要长期随访；脑电图、神经影像学评分和体感诱发电位对异常神经学转归具有预后价值。
