Radack D M, Baumgart S, Gross G W
Department of Radiology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania 19107.
Clin Pediatr (Phila). 1994 Oct;33(10):583-7. doi: 10.1177/000992289403301002.
Intracranial hemorrhage (ICH) is a potential contraindication to extracorporeal membrane oxygenation (ECMO) therapy in neonates, since systemic anticoagulation required during ECMO may increase the incidence and progression of ICH. To determine the frequency and the pattern of evolution of subependymal hemorrhage (SEH) (grade 1 ICH) in neonates on ECMO, the daily head ultrasound (HUS) examinations obtained as part of a prospective neurologic evaluation protocol in 212 ECMO patients were reviewed. Forty-three patients (20%) had a total of 65 SEHs. Twenty-two infants had bilateral SEH. Twenty-eight infants developed 38 SEHs during ECMO bypass after pre-ECMO HUS showed no evidence of ICH. An additional 18 neonates had a total of 22 SEHs demonstrated on pre-ECMO HUS. No pre-ECMO HUS was performed in four infants having a total of five SEHs first identified during ECMO bypass. Of the 65 SEHs, 59 (91%) remained stable or resolved during ECMO, while six (9%) evolved during ECMO--three to grade 2, one to grade 3, and two to grade 4 ICH. Our data suggest that SEH should not be considered a contraindication to ECMO bypass and very infrequently will progress significantly during ECMO.
颅内出血（ICH）是新生儿体外膜肺氧合（ECMO）治疗的潜在禁忌证，因为ECMO期间所需的全身抗凝可能会增加ICH的发生率和病情进展。为了确定接受ECMO治疗的新生儿室管膜下出血（SEH，1级ICH）的发生频率和演变模式，我们回顾了212例接受ECMO治疗患者前瞻性神经学评估方案中每日进行的头颅超声（HUS）检查结果。43例患者（20%）共发生65次SEH。22例婴儿发生双侧SEH。28例婴儿在ECMO转流期间出现38次SEH，而ECMO前HUS检查未发现ICH迹象。另有18例新生儿在ECMO前HUS检查中发现共22次SEH。4例婴儿共5次SEH首次在ECMO转流期间发现，未进行ECMO前HUS检查。在65次SEH中，59次（91%）在ECMO期间保持稳定或好转，而6次（9%）在ECMO期间病情进展——3次进展为2级，1次进展为3级，2次进展为4级ICH。我们的数据表明，SEH不应被视为ECMO转流的禁忌证，并且在ECMO期间很少会显著进展。
