目的 探讨心肺功能衰竭患儿体外膜肺(ECMO)支持治疗的临床经验.方法 回顾性分析2008年12月至2012年5月收住复旦大学附属儿科医院重症监护病房及心脏监护病房的9例危重症患儿接受ECMO治疗的情况及转归.结果 9例患儿均采用颈内动、静脉置管,V-A ECMO模式,体外肝素抗凝,活化凝血时间(ACT)维持在180～220 s;体外辅助血流量为50~100 mL·kg-1·min-1.治疗期间进行心肺功能、血液指标和影像学等监测.9例患儿ECMO使用时间为5~280 h,中位数112 h.经治疗后8例病情好转,撤离ECMO治疗,其中7例痊愈出院,1例撤离ECMO治疗后3 d自动出院.1例因室间隔缺损修补术后合并严重脓毒症、脓毒症休克和心肺功能衰竭,ECMO治疗1周,撤机后死亡.发生各类并发症共14例次,其中机械系统并发症6例次,包括氧合器漏液3例次,管路血栓2例次,水箱加温器故障1例次;机体并发症7例次,其中6例发生贫血,1例右上肢功能障碍;意外事件1例,患儿在ECMO运行过程中因右腋下动脉置管意外滑脱而形成血肿.未发生颅内并发症、出血和感染等.结论 ECMO能有效对危重症患儿行心肺功能支持,使用安全.建立一支专业的技术团队能促进ECMO的更好开展.%Objective To retrospectively analyze the clinical application of extracorporeal membrance oxygenation( ECMO ) support in 9 critically ill children who suffered from cardiac and/or pulmonary failure with no response to advanced treatment except ECMO or could not wean from cardiopulmonary bypass following cardiac surgery. Methods All 9 cases were collected from December 2008 to May 2012 in Childrens Hospital of Fudan University, and all received ECMO treatment. Four cases were from PICU and 5 were from CCU. Clinical data including age, sex, body weight, disease, clinical information before and after the treatment of ECMO and prognosis were reviewed. V-A ECMO was applied to all 9 cases after vessels cannulation or surgery. Heparin was given to each case to keep activated clotting time ( ACT ) between 180 and 220 seconds. Extracorporeal blood flow was set at 50 — 100 mL · kg-1? min-1 during the treatment of ECMO. Vital signs including cardiac ultrasound, chest X-ray and blood gas were monitored. Results The ECMO time varied from 5 to 280 hours,with median of 112 h. All patients weaned from ECMO successfully after cardiopulmonary function recovered. Seven of 9 cases survived and discharged from hospital and 1 kid gave up the treatment after termination of ECMO. One child with ECMO finally died of post-operative cardiopulmonary failure accompanied by refractory septic shock and pulmonary hypertension crisis. There were 14 episodes of complications during the treatment of ECMO, 6 of them were mechanical events, such as leakage of oxygenator, thrombosis developed in the ECMO tube system and heater machine failure. There were 6 body complications, including anemia and difficulty in moving right upper limb. One case had a hematoma due to accidental misplace of the invasive artery blood pressure line during the treatment of ECMO. No cerebral complications or intracranial hemorrhage as well as infections were found. Conclusions ECMO is an effective access to give cardiac pulmonary support for critically ill children. A skillful and good cooperative ECMO team is important for safely and successfully running of ECMO.
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