Chen Yu-Lan, Yang Xiu-Fang, Chen Jian, Shi Shang-Wen, Zhu Qiao-Wei, Liao Xiao-Zu, Zhang Ming-Guang
Department of Neonatology, Zhongshan People's Hospital, Zhongshan, Guangdong 528400, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2022 Jul 15;24(7):786-791. doi: 10.7499/j.issn.1008-8830.2202053.
To study the clinical value of extracorporeal membrane oxygenation (ECMO) in the treatment of persistent pulmonary hypertension of the newborn (PPHN).
A retrospective analysis was performed on the medical data of 11 neonates with PPHN who were treated with ECMO in the Neonatal Intensive Care Unit of Zhongshan People's Hospital from January 2015 to December 2021, involving the neonates' general information, clinical diagnosis, laboratory results, duration of ECMO treatment, complications during ECMO treatment, length of hospital stay, and outcome.
Of the 11 neonates, 10 (91%) had successful weaning from ECMO, and 8 (73%) survived. For the 11 neonates, the mean duration of ECMO treatment was (81±50) hours (range: 26 to 185 hours), the mean duration of ventilator use was (198±105) hours (range: 57 to 392 hours), and the mean length of hospital stay was (22±15) days (range: 2 to 49 days). The oxygenation index and blood lactate level were significantly improved after 24 hours of ECMO treatment among the 11 neonates (<0.05). Ten neonates had significantly reduced pulmonary artery pressure after 24 hours of ECMO treatment (<0.05). One neonate had a progressive increase in the pulmonary artery pressure during EMCO treatment, succumbing to death. This neonate was diagnosed with alveolar capillary dysplasia based on the histopathological findings of the lung tissue and whole-exome sequencing results. Among the 11 children, 5 had intracranial hemorrhage, 1 had disseminated intravascular coagulation, 1 had gastric hemorrhage, 2 had pulmonary hemorrhage, 1 had renal insufficiency, and 3 had bleeding at the puncture site during ECMO treatment.
ECMO is effective for the treatment of PPHN, however, the high incidence of complications of ECMO treatment suggests that it is important to carefully assess the indications and timing of ECMO treatment and improve the management of ECMO, which can improve the weaning rate and survival rate.
探讨体外膜肺氧合（ECMO）治疗新生儿持续性肺动脉高压（PPHN）的临床价值。
回顾性分析2015年1月至2021年12月在中山市人民医院新生儿重症监护病房接受ECMO治疗的11例PPHN新生儿的病历资料，包括患儿一般资料、临床诊断、实验室检查结果、ECMO治疗时间、ECMO治疗期间并发症、住院时间及预后情况。
11例患儿中，10例（91%）成功撤离ECMO，8例（73%）存活。11例患儿ECMO治疗平均时间为（81±50）小时（范围：26至185小时），呼吸机使用平均时间为（198±105）小时（范围：57至392小时），平均住院时间为（22±15）天（范围：2至49天）。11例患儿ECMO治疗24小时后氧合指数及血乳酸水平均显著改善（<0.05）。10例患儿ECMO治疗24小时后肺动脉压力显著降低（<0.05）。1例患儿在ECMO治疗期间肺动脉压力进行性升高，最终死亡。根据肺组织病理检查结果及全外显子测序结果，该患儿诊断为肺泡毛细血管发育不良。11例患儿中，5例发生颅内出血，1例发生弥散性血管内凝血，1例发生胃出血，2例发生肺出血，1例发生肾功能不全，3例在ECMO治疗期间出现穿刺部位出血。
ECMO治疗PPHN有效，但ECMO治疗并发症发生率高，提示应仔细评估ECMO治疗的适应证和时机，加强ECMO管理，以提高撤离成功率和生存率。
