Carter J M, Gerstmann D R, Clark R H, Snyder G, Cornish J D, Null D M, deLemos R A
Wilford Hall USAF Medical Center, Lackland AFB, Texas 78236-5000.
Pediatrics. 1990 Feb;85(2):159-64.
Forty-six (92%) outborn and four (8%) inborn term or near-term neonates were admitted for extracorporeal membrane oxygenation (ECMO) treatment to a neonatal intensive care unit between July 1, 1985, and November 1, 1987. All infants had PAO2-PaO2 greater than or equal to 600 mm Hg in spite of aggressive conventional ventilatory and pharmacologic therapy. All patients were offered rescue treatment with high-frequency oscillatory ventilation (HFOV), and only if there was no improvement in PAO2-PaO2 with HFOV were infants treated using ECMO. Four patients died before receiving an adequate trial of HFOV and before emergency ECMO support could be initiated; 21 patients, all of whom survived to hospital discharge, responded to HFOV; 25 patients ultimately required ECMO therapy for cardiopulmonary support, with 22 (88%) surviving to discharge. Neonates responding to HFOV were of slightly younger gestational age (38 +/- 2 weeks vs 40 +/- 2 weeks, mean +/- SD; P less than .001) and more frequently had clinical evidence of pneumonia (11 of 21 vs 2 of 25; P less than .002). There was no statistically significant difference in outcome with respect to the number of ventilator days, hospital days, or survival between patients responding to HFOV and patients who required ECMO. Morbidity was increased in ECMO patients, with bleeding abnormalities, seizures, and renal failure occurring more frequently than in HFOV-treated infants. Overall, 92% (46 of 50) of the patients were treated with a staged protocol using HFOV before ECMO. A total of 46% (21 of 46) responded to HFOV treatment alone and did not require ECMO therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
1985年7月1日至1987年11月1日期间，46名（92%）外出生及4名（8%）内出生的足月儿或近足月儿因体外膜肺氧合（ECMO）治疗被收治入新生儿重症监护病房。尽管采取了积极的传统通气和药物治疗，所有婴儿的肺泡氧分压（PAO2）与动脉血氧分压（PaO2）差值均大于或等于600 mmHg。所有患者均接受了高频振荡通气（HFOV）的抢救治疗，只有当HFOV治疗后PAO2 - PaO2无改善时，才对婴儿使用ECMO治疗。4名患者在接受充分的HFOV试验之前以及启动紧急ECMO支持之前死亡；21名患者对HFOV有反应，全部存活至出院；25名患者最终需要ECMO治疗以提供心肺支持，其中22名（88%）存活至出院。对HFOV有反应的新生儿孕周略小（平均±标准差：38±2周 vs 40±2周；P <.001），且更频繁地有肺炎的临床证据（21例中有11例 vs 25例中有2例；P <.002）。在呼吸机使用天数、住院天数或存活方面，对HFOV有反应的患者与需要ECMO的患者之间在结局上无统计学显著差异。ECMO患者的发病率增加，出血异常、癫痫发作和肾衰竭比接受HFOV治疗的婴儿更频繁发生。总体而言，92%（50例中的46例）患者采用了在ECMO之前先使用HFOV的分阶段方案进行治疗。共有46%（46例中的21例）仅对HFOV治疗有反应，不需要ECMO治疗。（摘要截选至250字）
