中国循证儿科杂志2025，Vol.20Issue(3)：176-180,5.DOI:10.3969/j.issn.1673-5501.2025.03.003
单中心新生儿体外膜肺氧合主动转运和院内治疗的回顾性队列研究
A retrospective cohort study of active transport and in-hospital treatment for neonatal extracorporeal membrane oxygenation at a single center
摘要
Abstract
Background Extracorporeal membrane oxygenation(ECMO)has become a key treatment for critical neonates.However,neonatal ECMO transport technology in China is still in its infancy and has been implemented in only a few pediatric hospitals,with limited relevant reports.Objective To analyze the rescue and outcomes of critical neonates treated with ECMO by our neonatal ECMO team and assess the efficacy and safety of ECMO transport technology.Design Retrospective cohort study.Methods Neonates who received ECMO treatment in the PICU and NICU of Children's Hospital of Fudan University from May 1,2015,to May 31,2024.Neonates with fatal congenital malformations,chromosomal abnormalities,or severe coagulation disorders were excluded.Included patients were grouped based on ECMO initiation location into the active transport group(ECMO initiated at the transferring hospital and transported to our hospital via ambulance by the 120 team and our ECMO team)and the in-hospital treatment group(ECMO initiated after cannulation in our hospital).Follow-up was conducted via outpatient or telephone visits until August 1,2024,and relevant clinical data were collected from our hospital's electronic medical record system.Main outcome measures Incidence of complications and hospital survival.Results Of the 21 neonates analyzed,13 were in the in-hospital group and 8 in the active transport group.The transport distance was 137.5(76.3,171.8)km and transport time was 1.9(1.4,2.2)h.There were 13 boys and 8 girls,with an average birth weight of(3416.9±491.8)g and gestational age of(39.7±0.9)weeks.The in-hospital group had a higher gestational age but a lower proportion of nitric oxide use,both statistically significant.There was no significant difference in basic characteristics,primary diseases,pre-ECMO treatments,during-ECMO treatments,and ECMO duration between the two groups.All neonates in both groups developed thrombocytopenia(100％)during ECMO treatment.In the in-hospital group,2 cases had intraventricular haemorrhage,and 1 case each of cerebral infarction,vocal cord palsy,cholestasis and abdominal compartment syndrome.Six cases(46.2％)were successfully weaned and discharged.Before discharge,5 cases had monotonous general movements on GMs assessment.Cranial MR showed 2 cases of IVH and 1 case of cerebral infarction with haemorrhage.One case had abnormal EEG,and BAEP indicated 3 cases of mild hearing loss.One case was lost to follow-up,and 5 cases had acceptable neurodevelopmental outcomes,with a follow-up duration of 7.4(4.4,8.4)years.In the active transport group,3 cases had gastrointestinal bleeding and 1 case had IVH.Four cases(50％)were successfully weaned and discharged.GMs assessment showed monotonous general movements in 4 cases,and cranial MR showed obvious lesions in 2 cases.Three cases had acceptable neurodevelopmental outcomes,and 1 case had adrenal insufficiency and hypothyroidism.The follow-up duration was 6.3(1.7,6.9)years.There were no statistically significant differences between the two groups in terms of discharge survival,causes of death,neurological assessment before discharge,hospital stay,hospital costs and follow-up duration.Conclusion ECMO active transport has a similar prognosis to in-hospital treatment.For critical neonates unable to undergo traditional transfer,ECMO active transport is a safe and relatively effective rescue option.关键词
新生儿/体外膜肺氧合/院际/主动转运Key words
Neonate/Extracorporeal membrane oxygenation(ECMO)/Inter-hospital/Active transport引用本文复制引用
赵玲,陆国平,王来栓,程晔,张文波,贺骏,周建国,张蓉,曹云,陈超,陈伟明..单中心新生儿体外膜肺氧合主动转运和院内治疗的回顾性队列研究[J].中国循证儿科杂志,2025,20(3):176-180,5.基金项目
国家重点研发计划:2021YFC2701800,2021YFC2701805 （）
