Glass P, Miller M, Short B
Department of Neonatology, Children's Hospital National Medical Center, Washington, DC 20010.
Pediatrics. 1989 Jan;83(1):72-8.
Extracorporeal membrane oxygenation is an important technology in the treatment of high-risk infants whose long-term outcome is being followed prospectively at our institution. The extracorporeal membrane oxygenation procedure allows temporary cardiopulmonary support for critically ill full-term neonates who are refractory to maximum ventilatory and medical management as a consequence of severe persistent pulmonary hypertension. The technique necessitates both the permanent ligation of the right common carotid artery and jugular vein and systemic heparinization. The survivors constitute a unique group of high-risk infants, from the standpoint of the hypoxic-ischemic insults preceding extracorporeal membrane oxygenation and the risks associated with the procedure. Our results indicate that most of our survivors are developing normally at 1 year. Major morbidity, in terms of either significant developmental delay (Bayley mental and motor indices less than 70) or significant neuromotor abnormality, occurred in only 10% of these infants. Poor outcome was associated with major intracranial hemorrhage and chronic lung disease. Ligation of the right carotid artery and jugular vein was not associated with a consistent lateralizing lesion. Long-term follow-up through school age is essential.
体外膜肺氧合是治疗高危婴儿的一项重要技术，我院正在对其长期预后进行前瞻性跟踪。体外膜肺氧合程序可为患有严重持续性肺动脉高压、对最大通气和药物治疗无效的重症足月新生儿提供临时心肺支持。该技术需要永久性结扎右侧颈总动脉和颈静脉，并进行全身肝素化。从体外膜肺氧合之前的缺氧缺血性损伤以及该程序相关风险的角度来看，幸存者构成了一组独特的高危婴儿。我们的结果表明，大多数幸存者在1岁时发育正常。这些婴儿中只有10%出现了严重发病率，表现为显著发育迟缓（贝利智力和运动指数低于70）或显著神经运动异常。不良预后与重大颅内出血和慢性肺病有关。右侧颈动脉和颈静脉结扎与一致的偏侧病变无关。对学龄期儿童进行长期随访至关重要。
