Arensman R M, Statter M B, Bastawrous A L, Madonna M B
Department of Surgery and Pediatrics, University of Chicago, Wyler Children's Hospital, Illinois 60637, USA.
Am J Surg. 1996 Jul;172(1):41-7. doi: 10.1016/s0002-9610(96)00057-8.
Respiratory failure secondary to a variety of causes remains a significant cause of morbidity and mortality in the pediatric population. Newer therapies are appearing frequently in an attempt to decrease the number of deaths from this disease state. We briefly review the current literature on some of the newer modalities including: high-frequency ventilation, surfactant, liquid ventilation, and nitric oxide. We then present our experience from the past 11 years in the most invasive, yet successful, therapy for acute respiratory failure-extracorporeal membrane oxygenation (ECMO).
Retrospective review of all patients treated with ECMO from September 1983 to December 1994 was undertaken. Data were collected from bedside ECMO flow sheets and the standardized data entry forms submitted to the Extracorporeal Life Support Organization. All statistical analyses were performed using a standard statistical software program.
During the study period, 194 neonates and 47 pediatric patients were treated with ECMO. The survival rate in the neonatal population is 82% and in the pediatric population it is 40%. The neonatal patients required an average of 153 hours of support while the pediatric patients required 220 hours (P = 0.008).
While the newer treatment modalities discussed may have an important role in treating neonatal and pediatric respiratory failure in the near future, ECMO remains a cornerstone of the modern treatment modalities. Although somewhat invasive, ECMO is effective therapy with increasing survival rates each year.
继发于多种病因的呼吸衰竭仍然是儿科人群发病和死亡的重要原因。为了减少因这种疾病状态导致的死亡人数，新的治疗方法不断涌现。我们简要回顾了一些关于较新治疗方式的当前文献，包括：高频通气、表面活性剂、液体通气和一氧化氮。然后我们介绍了过去11年中我们在治疗急性呼吸衰竭最具侵入性但却最成功的疗法——体外膜肺氧合（ECMO）方面的经验。
对1983年9月至1994年12月期间所有接受ECMO治疗的患者进行回顾性研究。数据收集自床边ECMO流程表以及提交给体外生命支持组织的标准化数据录入表格。所有统计分析均使用标准统计软件程序进行。
在研究期间，194例新生儿和47例儿科患者接受了ECMO治疗。新生儿人群的生存率为82%，儿科人群的生存率为40%。新生儿患者平均需要153小时的支持，而儿科患者需要220小时（P = 0.008）。
虽然所讨论的新治疗方式在不久的将来可能在治疗新生儿和儿科呼吸衰竭中发挥重要作用，但ECMO仍然是现代治疗方式的基石。尽管ECMO有一定的侵入性，但它是一种有效的治疗方法，且每年的生存率都在提高。
