谢添 1梅红芳 1杨丽君 2许燕萍 1施丽萍 1马晓路 1陈正1
作者信息
- 1. 浙江大学医学院附属儿童医院,国家儿童健康与疾病临床医学研究中心 NICU,杭州,310052
- 2. 浙江大学医学院附属儿童医院,国家儿童健康与疾病临床医学研究中心 心衰/机械辅助循环科,杭州,310052
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摘要
Abstract
Background Extracorporeal membrane oxygenation(ECMO)can be utilized in the treatment of various critical neonatal diseases.However,ECMO technology was introduced relatively late in China,resulting in limited clinical experience.Ob-jective To summarize the clinical experience of ECMO in the treatment of critically ill neonates.Design Case series report.Meth-ods Retrospectively analyzed the clinical data of neonates who received ECMO treatment in the NICU of Children's Hospital,Zhe-jiang University School of Medicine from July 2018 to July 2024.It included gender,gestational age,birth weight,primary dis-ease,oxygenation index before ECMO,ECMO mode,ECMO operation status and complications,carotid artery management after withdrawal,duration of invasive ventilation,and neonate outcomes.Main outcome measures Survival to discharge.Results A total of 16 neonates were included,6 males and 10 females,a gestational age of 39.1 weeks(range:36-41 weeks)and birth weight of 3,400 g(range:2,700-4,550 g).The primary diseases included meconium aspiration syndrome in 3 cases,persistent pulmonary hypertension of the newborn in 9 cases,septic shock in 3 cases,congenital diaphragmatic hernia in 1 case.Fifteen cases were directly established on venoarterial ECMO(VA-ECMO)support.The remaining one case initially received venovenous ECMO(VV-ECMO)but was converted to VA-ECMO due to subsequent circulatory collapse.The median duration of ECMO sup-port was 112 hours(range:15-190)hours,and 4 neonates underwent carotid artery reconstruction after ECMO withdrawal,while the carotid arteries of other neonates were ligated.A total of 11 neonates survived,with a survival rate of 68.8%,and the median duration of invasive ventilation was 9 days(range:1-20),with a median hospital stay of 20.5 days(range:1-67 days).Complica-tions related to ECMO included Circuit malfunction in 2 cases,hemolysis in 2 cases,cerebral infarction in 2 cases,atrial thrombus in 1 case,intracranial hemorrhage in 2 cases,and pulmonary hemorrhage in 1 case.Conclusion ECMO is an effective treatment for severe respiratory and circulatory failure in newborns,but it may cause various complications.Indications need to be strictly fol-lowed and refined management is required to improve the prognosis of the infants.关键词
新生儿/体外膜肺氧合/呼吸衰竭/并发症Key words
Neonate/Extracorporeal membrane oxygenation/Respiratory failure/Complication
