摘要
目的评估体外膜肺氧合(ECMO)辅助治疗儿童休克的临床特点及预后情况。方法回顾性分析河南省儿童医院2019年1月至2023年12月因休克行ECMO治疗的35例休克患儿的临床资料及预后,并比较存活组与死亡组ECMO上机前24h的实验室指标。结果35例患儿中心源性休克30例,脓毒性休克5例。心源性休克患儿存活率为50%,脓毒性休克患儿存活率为60%。患儿总体ECMO治疗撤机成功率为65.71%,心源性休克组为66.67%,脓毒性休克组为60%。平均ECMO应用时长为4.95±0.50d。ECMO支持期间并发症/合并症包括肝损伤、肾损伤、出血、血栓、感染、胰腺损伤、脑水肿等。死亡组总胆红素、谷丙转氨酶(ALT)、谷草转氨酶(AST)、肌酐、乳酸脱氢酶(LDH)、凝血酶原时间(PT)、部分活化凝血酶原时间(APTT)、白介素-6(IL-6)、乳酸均显著高于存活组,差异有统计学意义(P<0.05)。随访至出院后6个月,ECMO存活组患儿多数遗留心血管系统/神经系统后遗症。结论ECMO辅助休克患儿存活率为51.43%,撤机成功率为65.71%。ECMO支持期间并发症/合并症以肝肾功能损伤、出血、血栓为主。ECMO上机前24h内总胆红素、ALT、AST、肌酐、LDH、PT、APTT、IL-6、乳酸水平显著升高可能提示患儿预后不良。ECMO幸存患儿后期易遗留不同程度并发症,需长期随访、积极干预。
Objective To summarize the clinical features and prognosis of extracorporeal membrane pulmonary oxygenation(ECMO)-assisted treatment of shock in children.Methods To retrospectively analyze the clinical data and prognosis of 35 children treated with ECMO for shock in Henan Children's Hospital from January 2019 to December 2023,and to compare the laboratory indexes of the surviving group with those of the deceased group 24 hours before ECMO on board.Results The 35 children included 30 cases of cardiogenic shock and 5 cases of septic shock.The survival rate was 50%for children with cardiogenic shock and 60%for children with septic shock.The overall ECMO treatment withdrawal success rate of the children was 65.71%,66.67%in the cardiogenic shock group and 60%in the septic shock group.The mean duration of ECMO application was 4.95±0.50 days.Complications/comorbidities during ECMO support included hepatic injury,renal injury,hemorrhage,thrombosis,infection,pancreatic injury,and cerebral edema.Total bilirubin,alanine aminotransferase(ALT),albumin transaminase(AST),creatinine,lactate dehydrogenase(LDH),prothrombin time(PT),partially activated prothrombin time(APTT),interleukin-6(IL-6),and lactic acid were significantly higher in the death group than in the survival group,and the difference was statistically significant(P<0.05).Follow-up to 6 months after discharge,most of the children in the ECMO survival group had residual cardiovascular/neurological sequelae.Conclusions The survival rate of children with ECMO-assisted shock was 51.43%,and the withdrawal success rate was 65.71%.Complications/comorbidities during ECMO support were mainly hepatic and renal impairments,hemorrhage,and thrombosis.Significantly elevated levels of total bilirubin,ALT,AST,creatinine,LDH,PT,APTT,IL-6,and lactic acid in the 24 hours prior to ECMO on-boarding may indicate a poor prognosis for the children.Children surviving ECMO are prone to various degrees of complications and require long-term follow-up and active intervention.
作者
贾婉玉
全雪丽
宋春兰
王洁
成怡冰
Jia Wanyu;Quan Xueli;Song Chunlan;Wang Jie;Cheng Yibing(Henan Children's Hospital,Zhengzhou Children's Hospital;Henan Province Engineering Research Center of Diagnosis and Treatment of Pediatric Infection and Critical Care,Zhengzhou,China)
基金
2022年河南省联合共建项目(项目编号:LHGJ20220755)
关键词
体外膜肺氧合
心源性休克
脓毒性休克
Extracorporeal membrane pulmonary oxygenation
Cardiogenic shock
Septic shock
作者简介
通信作者:成怡冰,E-mail:13703829317@163.com
