摘要
Abstract
Objective To retrospectively analyze the safety and clinical value of bronchoscopy with veno-arterial extracorporeal membrane oxygenation(V-A ECMO)support for circulatory failure in children with congenital heart defect heart disease(CHD).Methods A retrospective analysis was performed on patients who received V-A ECMO support after CHD surgery between January 2020 and October 2022 in Shanghai Children's Medical Center.They were divided into two groups according to whether or not bronchoscopy was performed:bronchoscopy group(Group A)and no bronchoscopy group(Group B).Results A total of 101 cases were enrolled,42 cases in Group A(41.6%).The median time of bronchoscopy was day 5 of ECMO support.Compared with Group B,Group A had longer duration of ECMO,higher incidence of atelectasis and pulmonary infection,but shorter duration of mechanical ventilation after ECMO withdrawal.There was no difference in the total length of ICU stay and mortality between the two groups.The incidence of atelectasis during ECMO was 49.5%,37 cases in Group A and 13 cases in Group B.The median time of atelectasis onset was the third day of ECMO support.The total incidence of pulmonary infection was 54.5%,30 cases in Group A and 25 cases in Group B.In Group A,15 cases(35.7%)were found to have constriction or stenosis of bronchus,and 24 cases(57.1%)were found to have obstruction of sputum by bronchoscopy.In 12 of them,hypoxemia was found in the ECMO withdrawal test.After bronchoscopy and treatment,the ventilation condition of the ventilator was decreased.The next day,the withdrawal test was carried out again,and the ECMO was successfully withdrawn.Among 42 cases of bronchoscopy,2 cases had slight airway hemorrhage and pulmonary hemorrhage,and no complications such as ECMO flow change,circulation fluctuation and pneumothorax.Pathogenic microorganisms were found in bronchoalveolar lavage fluid of 22 cases.Conclusion The bronchoscopy is safe during ECMO,it is beneficial to the diagnosis and treatment of pulmonary complications in children with V-A ECMO after CHD,and it can shorten the time of mechanical ventilation in children with V-A ECMO after ECMO withdrawal,it is of clinical value for the successful withdrawal of ECMO.关键词
先天性心脏病/术后/静脉-动脉体外膜氧合/纤维支气管镜检查Key words
Congenital heart disease/Postoperation/Veno-arterial extracorporeal membrane oxygenation/Fiberoptic bronchoscopy
