以脐静脉作为再灌注途径在新生儿中进行静脉-静脉体外膜肺氧合。

Venovenous extracorporeal membrane oxygenation in newborn infants using the umbilical vein as a reinfusion route.

作者信息

Kato J, Nagaya M, Niimi N, Tanaka S

机构信息

Department of Pediatric Surgery, Central Hospital, Aichi Prefectural Colony, Kasugai, Japan.

出版信息

J Pediatr Surg. 1998 Sep;33(9):1446-8. doi: 10.1016/s0022-3468(98)90035-5.

DOI:10.1016/s0022-3468(98)90035-5

PMID:9766381

Abstract

PURPOSE

The authors report on four neonates treated with venovenous (VV) extracorporeal membrane oxygenation (ECMO) using the umbilical vein as a reinfusion route.

METHODS

From 1994 to 1997, 26 instances VV-ECMO in neonates have been carried out at our neonatal center for the treatment of severe respiratory and cardiac failure. Among them, 22 patients could be treated with VV-ECMO mainly using 15F double-lumen catheter (DLC), adding the cephalic drainage using another catheter. In the remaining four cases, however, attempts to insert the DLC into the right internal jugular vein failed because the vein was too small or technical problems. For such instances, two catheters were cannulated into the right atrium and the cephalic portion of the right internal jugular vein, respectively. These two venous catheters were connected to the drainage route of ECMO circuit with a "Y" connector. Then, the umbilical vein was cannulated with 10F or 8F catheter, which was connected to the reinfusion route of ECMO to return the oxygenated blood to the infant.

RESULTS

The median age at which ECMO was initiated was 18 hours, and the median ECMO course was 72 hours. The liver function tests were slightly and transiently worsened in two patients during VV perfusion, (in one patient serum glutamic-oxaloacetic transaminase [SGOT] elevated to 76 IU/L and serum glutamic-pyruvic transaminase [SGPT] to 49 IU/L, and in another patient SGOT elevated to 56 IU/L and SGPT remained in normal range). Preumbilical cannula pressures were measured in two patients. In a patient who used 10F umbilical cannula, the preumbilical maximum pressure was 43 mm Hg at 250 mL/min of ECMO flow. In another with an 8F catheter, it was 72 mm Hg at 180 mL/min of ECMO flow. All of the patients survived without any neurological complications.

CONCLUSIONS

If the right internal jugular vein would not accommodate the DLC, VV-ECMO using the umbilical vein as a infusion route could be selected.

摘要

目的

作者报告了4例使用脐静脉作为再灌注途径接受静脉-静脉（VV）体外膜肺氧合（ECMO）治疗的新生儿情况。

方法

1994年至1997年，我们新生儿中心对26例新生儿实施了VV-ECMO，用于治疗严重呼吸和心力衰竭。其中，22例患者主要使用15F双腔导管（DLC）进行VV-ECMO治疗，并使用另一根导管进行头部引流。然而，在其余4例中，由于静脉过小或技术问题，将DLC插入右颈内静脉的尝试失败。对于这些情况，分别将两根导管插入右心房和右颈内静脉头部段。这两根静脉导管通过一个“Y”形连接器连接到ECMO回路的引流途径。然后，用10F或8F导管插入脐静脉，该导管连接到ECMO的再灌注途径，将氧合血回输到婴儿体内。

结果

开始ECMO治疗的中位年龄为18小时，中位ECMO疗程为72小时。在两名患者的VV灌注期间，肝功能检查轻度且短暂恶化（一名患者血清谷草转氨酶[SGOT]升高至76 IU/L，血清谷丙转氨酶[SGPT]升高至49 IU/L；另一名患者SGOT升高至56 IU/L，SGPT保持在正常范围内）。对两名患者测量了脐插管前压力。一名使用10F脐插管的患者，在ECMO流量为250 mL/min时，脐插管前最大压力为43 mmHg。另一名使用8F导管的患者，在ECMO流量为180 mL/min时，压力为72 mmHg。所有患者均存活，无任何神经并发症。