| 摘要: |
| ［摘要］ 目的 分析急性呼吸衰竭需体外膜肺氧合（ECMO）支持治疗患儿的病原学及临床因素对结局的影响。方法 收集2019年1月至2023年6月在广西壮族自治区人民医院儿童重症监护室（PICU）住院的因急性呼吸衰竭行ECMO支持治疗的28例患儿的临床资料，分析年龄、性别、原发疾病、病原学、ECMO支持模式、ECMO上机前后的P/F指数及乳酸水平、上机前Murray肺损伤评分、ECMO支持时长、ECMO前后机械通气时长等对ECMO结局的影响。结果 28例接受ECMO治疗的急性呼吸衰竭患儿中存活17例，死亡11例；细菌感染5例，病毒感染9例，细菌及病毒混合感染6例，病原菌阴性者8例。存活组与死亡组患儿在ECMO前P/F指数、乳酸水平、ECMO支持时长、ECMO前后机械通气时长比较差异无统计学意义（P>0.05），ECMO支持模式差异有统计学意义(P<0.05)。细菌感染组、病毒感染组、细菌+病毒混合感染组及阴性组在ECMO前后P/F指数和乳酸水平、ECMO支持时长、ECMO后机械通气时长及结局方面比较差异无统计学意义（P>0.05），但在ECMO前Murray肺损伤评分方面差异有统计学意义(P<0.05)，以细菌+病毒混合感染组评分最高。结论 病原学情况对肺部Murray肺损伤评分有影响，但对ECMO支持时长、ECMO后机械通气时长及ECMO的结局无明显影响。此外，静脉-动脉体外膜肺氧合（VA-ECMO）与静脉-静脉体外膜肺氧合（VV-ECMO）模式对患儿的生存结局亦有影响。 |
| 关键词: 体外膜肺氧合 急性呼吸衰竭 病原学 儿童 结局 |
| DOI：10.3969/j.issn.1674-3806.2023.07.08 |
| 分类号:R 725.6 |
| 基金项目:广西卫生健康委科研课题（编号：Z-A 20220124） |
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| Analysis of the etiology of acute respiratory failure in children receiving ECMO support and the effects of clinical factors on the outcomes |
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HUANG Han-wu, LIANG Zhen-hua, WANG Min, et al.
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Pediatric Intensive Care Unit, the People′s Hospital of Guangxi Zhuang Autonomous Region(Guangxi Academy of Medical Sciences), Nanning 530021, China
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| Abstract: |
| ［Abstract］ Objective To analyze the etiology of acute respiratory failure(ARF) in children receiving extracorporeal membrane oxygenation(ECMO) support and the effects of clinical factors on the outcomes. Methods The clinical data of 28 children who were hospitalized in the Pediatric Intensive Care Unit(PICU) of the People′s Hospital of Guangxi Zhuang Autonomous Region from January 2019 to June 2023 and received ECMO supportive treatment due to ARF were collected. The pediatric patients′age, gender, primary diseases, etiology, ECMO support modes, P/F index and lactic acid levels before and after ECMO, Murray lung injury score before ECMO, time of ECMO support, the effects of invasive respiratory support durations before and after ECMO on the outcomes of ECMO were analyzed. Results Of the 28 pediatric patients with acute respiratory failure who received ECMO treatment, seventeen cases survived and 11 cases died; five cases had bacterial infection, and 9 cases had viral infection, and 6 cases had mixed infection of bacteria and viruses, and 8 cases tested negative for pathogenic microbe. There were no statistically significant differences in the P/F index before ECMO, lactic acid levels, time of ECMO support, and durations of mechanical ventilation before and after ECMO between the survival group and the death group(P>0.05), and the differences in the ECMO support modes were statistically significant(P<0.05). There were no statistically significant differences in the P/F index before and after ECMO, lactic acid levels before and after ECMO, time of ECMO support, duration of mechanical ventilation after ECMO and the outcomes among the bacterial infection group, viral infection group, bacterial+viral mixed infection group and negative pathogenic microbe group(P>0.05). However, there were statistically significant differences in Murray lung injury scores before ECMO among the four groups(P<0.05), and the scores in the bacterial+viral mixed infection group were the highest. Conclusion Different etiologies have effects on the Murray lung injury score in the lungs, but have no significant effects on the time of ECMO treatment, duration of mechanical ventilation after ECMO and the outcomes of ECMO. In addition, the veno-arterial extracorporeal membrane oxygenation(VA-ECMO) and veno-venous extracorporeal membrane oxygenation(VV-ECMO) modes have effects on the survival outcomes of pediatric patients. |
| Key words: Extracorporeal membrane oxygenation(ECMO) Acute respiratory failure(ARF) Etiology Children Outcome |
