Lally K P, Breaux C W
Department of Surgery, University of Texas Health Science Center, Houston 77030.
Surgery. 1995 Feb;117(2):175-8. doi: 10.1016/s0039-6060(05)80082-0.
Extracorporeal membrane oxygenation (ECMO) is an effective therapy for infants with severe respiratory failure and pulmonary hypertension. In most patients once the disease reverses, it does not recur. However, in some patients pulmonary hypertension recurs and these infants meet criteria for a second course of ECMO. We evaluated the survival rate and feasibility of a second course of ECMO in neonates.
A questionnaire was sent to all active ECMO programs that requested data about patients who received two courses of ECMO. A retrospective review of the results from responding centers was performed to evaluate indications and outcome.
The overall survival rate for the 58 neonates was 40%. Thirty-four patients with congenital diaphragmatic hernia had a survival rate of 47%, and 12 infants with primary persistent pulmonary hypertension had an 8% survival rate (p < 0.05). Most patients were treated with venoarterial ECMO for both courses.
There is a reasonable survival rate for selected neonates who are treated with a second course of ECMO. Infants with primary persistent pulmonary hypertension should be carefully examined before institution of a second course of ECMO.
体外膜肺氧合（ECMO）是治疗重症呼吸衰竭和肺动脉高压婴儿的有效疗法。大多数患者病情一旦好转，就不会复发。然而，部分患者会出现肺动脉高压复发，这些婴儿符合接受第二疗程ECMO的标准。我们评估了新生儿接受第二疗程ECMO的生存率和可行性。
向所有正在开展ECMO项目的机构发送调查问卷，要求提供接受两疗程ECMO治疗患者的数据。对回复中心的结果进行回顾性分析，以评估适应证和治疗结果。
58例新生儿的总体生存率为40%。34例先天性膈疝患者的生存率为 4 7%，12例原发性持续性肺动脉高压婴儿的生存率为8%（p<0.05）。大多数患者两疗程均采用静脉-动脉ECMO治疗。
接受第二疗程ECMO治疗的部分新生儿有合理的生存率。在开始第二疗程ECMO治疗前，应对原发性持续性肺动脉高压婴儿进行仔细评估。
