Kennaugh J M, Kinsella J P, Abman S H, Hernandez J A, Moreland S G, Rosenberg A A
Department of Pediatrics, University of Colorado School of Medicine, Denver, USA.
J Perinatol. 1997 Sep-Oct;17(5):366-9.
To determine the impact of new treatment modalities, including high-frequency oscillatory ventilation (HFOV) and inhaled nitric oxide (INO), on extracorporeal membrane oxygenation (ECMO) use and outcome of neonatal patients with persistent pulmonary hypertension of the newborn.
We reviewed the medical records of neonatal patients meeting established ECMO criteria from 1988 to 1995. Clinical data were gathered from this retrospective chart review. Comparison of ECMO experiences were made between the 1988-90 period (pre-HFOV and INO, or period 1) and the 1993-95 period (HFOV and INO fully established as treatment modalities, or period 2).
One hundred three patients were treated with ECMO during the 8-year study period. After HFOV and INO were introduced in 1991 and 1992 respectively, the number of patients meeting established ECMO criteria who subsequently required ECMO therapy progressively declined, from 22.3 +/- 2.3 (mean +/- SD) patients per year during period 1 to 12 patients in 1991 when HFOV was introduced, 8 patients in 1992 when INO was introduced, and 5.3 +/- 2.9 patients per year in period 2. The number of patients referred for ECMO over time did not change. Survival after ECMO dropped from 84% during period 1 to 56% in period 2. Introduction of new pre-ECMO therapies has not delayed institution of ECMO, significantly increased the length of ECMO runs, or lengthened the hospital course of ECMO survivors. A comparison of the eight infants treated with ECMO in 1992 with the 10 infants treated with INO in 1993 showed a longer hospital stay and a larger average patient bill for the patients treated with ECMO.
New treatment approaches for severe persistent pulmonary hypertension have reduced ECMO use, shortened the duration of hospitalization, and reduced costs for those infants responding to HFOV and INO. However, survival of patients requiring ECMO therapy has decreased.
确定包括高频振荡通气（HFOV）和吸入一氧化氮（INO）在内的新治疗方式对新生儿持续性肺动脉高压患者体外膜肺氧合（ECMO）使用情况及预后的影响。
我们回顾了1988年至1995年符合既定ECMO标准的新生儿患者的病历。通过这次回顾性图表审查收集临床数据。对1988 - 1990年期间（HFOV和INO应用前，即时期1）和1993 - 1995年期间（HFOV和INO作为治疗方式已全面确立，即时期2）的ECMO使用经验进行比较。
在8年的研究期间，103例患者接受了ECMO治疗。在1991年和1992年分别引入HFOV和INO后，符合既定ECMO标准且随后需要ECMO治疗的患者数量逐渐下降，从时期1的每年22.3±2.3（均值±标准差）例患者降至1991年引入HFOV时的12例、1992年引入INO时的8例以及时期2的每年5.3±2.9例患者。随着时间推移，转介接受ECMO治疗的患者数量没有变化。ECMO治疗后的生存率从时期1的84%降至时期2的56%。新的ECMO前治疗方法并未延迟ECMO的启动，未显著增加ECMO治疗时间，也未延长ECMO存活者的住院病程。对1992年接受ECMO治疗的8例婴儿与1993年接受INO治疗的10例婴儿进行比较，结果显示接受ECMO治疗的患者住院时间更长，平均患者费用更高。
针对严重持续性肺动脉高压的新治疗方法减少了ECMO的使用，缩短了住院时间，并降低了对HFOV和INO有反应的婴儿的治疗成本。然而，需要ECMO治疗的患者生存率有所下降。
