| 摘要: |
| ［摘要］ 目的 总结体外膜肺氧合（ECMO）救治儿童难治性心功能衰竭过程中左心引流的时机、风险和管理体会。方法 回顾性分析2015年1月至2023年2月浙江大学医学院附属儿童医院对难治性心功能衰竭患儿实施ECMO支持并行左心引流10例的治疗情况。并通过对PubMed、中国知网（CNKI）、万方数据库进行检索，对2000年1月至2023年2月数据库中报道的儿童ECMO下左心减压的病例进行文献总结复习。结果 10例患者中6例为暴发性心肌炎并心源性休克，4例为先天性心脏病术后（3例术中脱机困难，1例术后心跳骤停）。死亡6例，存活4例。ECMO支持时间36～476 h，左心引流支持时间36～460 h。严重并发症包括颅内出血引起脑疝（2例）、脑梗伴肢体偏瘫（2例）、左室血栓（1例）。死亡原因为心功能不能恢复（4例）、脑疝（2例）。文献检索出4个研究机构关于儿童左心减压病例汇报。该中心临床结果结合文献对照分析。结论 左心引流能够有效卸载左室前负荷，促进心脏功能恢复。合理把握左心引流时机，预防出凝血，优化体循环/左心引流比例等管理细节，可降低重大并发症发生率。 |
| 关键词: 体外膜肺氧合 左心减压 心功能衰竭 儿童 暴发性心肌炎 |
| DOI：10.3969/j.issn.1674-3806.2023.07.02 |
| 分类号:R 725.4 |
| 基金项目: |
|
| Clinical experience of 10 cases of refractory heart failure in children treated with left atrial drainage under extracorporeal membrane oxygenation and literature review |
|
ZONG Qing, YANG Li-jun, LIN Ru
|
|
Department of Cardiopulmonary Bypass and Extracorporeal Life Support, Children′s Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, Hangzhou 310052, China
|
| Abstract: |
| ［Abstract］ Objective To summarize the timing, risk and management experience of left atrial drainage during extracorporeal membrane oxygenation(ECMO) for treatment of pediatric refractory heart failure. Methods From January 2015 to February 2023, the treatment results of 10 refractory heart failure children who were performed ECMO support and left atrial drainage in Children′s Hospital of Zhejiang University School of Medicine were retrospectively analyzed. The databases of PubMed, China National Knowledge Infrastructure(CNKI) and Wanfang were retrieved, and a literature review of left atrial decompression in the pediatric cases with ECMO reported in the databases from January 2000 to February 2023 was conducted. Results Of the 10 patients, 6 cases suffered from fulminant myocarditis complicated with cardiac shock, and 4 cases had postoperative cardiac shock after congenital heart surgery(Three cases had difficulty in weaning from CPB and 1 case had postoperative cardiac arrest). Six cases died and 4 cases survived. The ECMO duration was 36-476 hours, and the left atrial drainage duration was 36-460 hours. The severe complications included cerebral hernia caused by intracranial hemorrhage(2 cases), cerebral infarction complicated with hemiplegia(2 cases), and left ventricular thrombosis(1 case). The causes of death were irreversible cardiac failure(4 cases) and cerebral hernia(2 cases). The case reports on left atrial decompression in children from four research institutions were retrieved from the literature. The clinical results of our center were compared with those of the literature. Conclusion Left atrial drainage can effectively unload left ventricular preload and promote the recovery of cardiac function. Reasonable management details such as timing of left atrial drainage, preventing coagulation and optimizing the ratio of systemic circulation to left atrial drainage can reduce the incidence of severe complications. |
| Key words: Extracorporeal membrane oxygenation(ECMO) Left atrial decompression Cardiac failure Children Fulminant myocarditis |
