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[单中心小儿体外膜肺氧合治疗的结果]

[Outcome of pediatric extracorporeal membrane oxygenation in a single center].

作者信息

Bao Q, Hong X Y, Liu Y Y, Zhang X J, Gao H T, Feng Z C

机构信息

Pediatric Intensive Care Unit, Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of the Peoples's Liberation Army (PLA), Beijing 100007, China.

出版信息

Zhonghua Er Ke Za Zhi. 2018 Feb 2;56(2):122-127. doi: 10.3760/cma.j.issn.0578-1310.2018.02.009.

Abstract

To investigate the application and outcome of pediatric extracorporeal membrane oxygenation (ECMO) in a single center. The clinical data of 52 pediatric patients with cardiopulmonary failure received ECMO support in Bayi Children's Hospital Affiliated to General Hospital of Beijing Military Command of PLA were collected from January 2012 to October 2016. All patients were divided into two stages by time. January 2012 to December 2014 was stage one. January 2015 to October 2016 was stage two. A retrospective analysis was done for these patients between two stages. In addition, all clinical data were compared with the data of extracorporeal life support organization (ELSO). The constituent ratio differences in different groups were tested by chi square test. In 52 cases, there were 40 boys and 12 girls, aging from 1 day to 7 years, weighing from 2 to 20 kg. There were 35 cases who successfully weaned from ECMO (67%), and 25 cases were able to be discharged alive (48%). In stage one, there were 24 ECMO cases, 18 boys and 6 girls. There were 15 cases successfully weaned from ECMO (63%). Nine patients survived until discharge (38%). Complications were found in 15 cases during ECMO support (63%). In stage two, there were 28 ECMO cases, 22 were boys and 6 were girls. There were 20 cases successfully weaned from ECMO (71%). Sixteen patients survived until discharge (57%). Complications were found in 12 cases during ECMO support (43%). There was no significant difference in survival rates between two stages. However, the neonatal survival rate was higher in stage two than in stage one (71% (12/28) . 31% (5/24), χ(2)=5.107, 0.038). The proportion of respiratory support was higher in stage two than in stage one (50% (14/28) . 21% (5/24), χ(2)=4.741, 0.029), while the proportion of extracorporeal cardiopulmonary resuscitation (ECPR) decreased significantly (21% (6/28) . 67% (16/24), χ(2)=10.835, 0.001). Application of peritoneal dialysis treatment in stage two was higher (6 . 0 cases, χ(2)=8.097, 0.025). Mortality of ECMO was still higher than that of ELSO (48% (25/52) . 62% (34 655/55 886), χ(2)=4.281, 0.05). The constituent ratio of different types of support varied between ECMO and ELSO patients (χ(2)=19.562, 0.001). ECMO technology can provide effective support for severe cardiopulmonary failure in critically ill children. Due to the multidisciplinary nature of ECMO technology, the complexity and characteristics of pediatric patients, it takes long time to improve ECMO management and prognosis.

摘要

探讨单中心小儿体外膜肺氧合(ECMO)的应用情况及治疗效果。收集2012年1月至2016年10月期间在北京军区总医院附属八一儿童医院接受ECMO支持的52例小儿心肺功能衰竭患者的临床资料。所有患者按时间分为两个阶段。2012年1月至2014年12月为第一阶段。2015年1月至2016年10月为第二阶段。对两个阶段的患者进行回顾性分析。此外,将所有临床资料与体外生命支持组织(ELSO)的数据进行比较。采用卡方检验比较不同组间的构成比差异。52例患者中,男40例,女12例,年龄1天至7岁,体重2至20 kg。35例患者成功撤离ECMO(67%),25例患者存活出院(48%)。第一阶段,ECMO治疗24例,男18例,女6例。15例患者成功撤离ECMO(63%)。9例患者存活至出院(38%)。ECMO支持期间15例出现并发症(63%)。第二阶段,ECMO治疗28例,男22例,女6例。20例患者成功撤离ECMO(71%)。16例患者存活至出院(57%)。ECMO支持期间12例出现并发症(4 . 3%)。两个阶段的生存率差异无统计学意义。然而,第二阶段新生儿生存率高于第一阶段(71%(12/28)对31%(5/24),χ² = 5.107,P = 0.038)。第二阶段呼吸支持比例高于第一阶段(50%(14/28)对21%(5/24),χ² = 4.741,P = 0.029),而体外心肺复苏(ECPR)比例显著下降(21%(6/28)对67%(16/24),χ² = 10.835,P = 0.001)。第二阶段腹膜透析治疗的应用比例更高(6对0例,χ² = 8.097,P = 0.025)。ECMO的死亡率仍高于ELSO(48%(25/52)对62%(34 655/55 886),χ² = 4.281,P = 0.05)。ECMO与ELSO患者不同类型支持的构成比存在差异(χ² = 19.562,P = 0.001)。ECMO技术可为危重症小儿严重心肺功能衰竭提供有效支持。由于ECMO技术的多学科性质、小儿患者的复杂性和特殊性,改善ECMO管理及预后需要较长时间。

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