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目的尽管体外膜肺(ECMO)是心脏术后难治性心衰患儿可接受的治疗策略,但在左心发育不良综合征I期重建术后的作用及其可变性,尚存争议。本研究目的是评价I期重建术后非选择ECMO治疗的预后。设计病例回顾地点儿童重症监护室研究对象1998年1月~2005年5月I期重建术后采用ECMO治疗的婴儿。干预无测量和主要结果研究期间共完成左心发育不良I期重建手术382例,36例术后需ECMO治疗。ECMO指征包括无法停用体外循环14例,心脏停搏22例。14例(38·8%)存活出院。死亡患儿体外循环时间较长[(150·1±70·0)minvs(103·9±30·0)min,P=0·01]。9/14(64%)存活婴儿术后ECMO时间>24h,而5/22(22%)存活婴儿ECMO时间<24h(P=0·02)。所有5例诊断为急性分流血栓症的婴儿早期均存活。生存者ECMO平均时间(50·1±12·5)h,死亡者(125·2±25·0)h(P=0·01)。7/14早期存活者的平均随访时间为20个月(2~78个月)。结论根据我们的经验,ECMO治疗可挽救I期重建术后1/3濒死患儿的生命。尤其适用于潜在可逆性疾病,如急性分流血栓症和短暂心室功能障碍。
Purpose Although extracorporeal membrane lung (ECMO) is an acceptable treatment strategy in children with refractory heart failure after cardiac surgery, the role and variability in I-PHD after I-phase reconstruction remains controversial. The purpose of this study was to evaluate the prognosis of non-selected ECMO after I-phase reconstruction. Design Case Review Location Children’s Intensive Care Unit Subjects January 1998-May 2005 Infants who received ECMO after I reconstruction. 382 cases of left-ventricular dysplasia I-phase reconstruction were completed during the measurement-free and primary outcome studies, and 36 cases were treated with ECMO. ECMO indications include the failure to disable cardiopulmonary bypass in 14 cases and cardiac arrest in 22 cases. Fourteen patients (38.8%) were discharged alive. Cardiopulmonary bypass time was longer in children with death [(150 · 1 ± 70 · 0) minvs (103 · 9 ± 30 · 0) min, P = 0.01]. In 9/14 (64%) surviving infants, the ECMO time was> 24 h, whereas in 5/22 (22%) surviving infants ECMO was <24h (P = .02). All 5 infants diagnosed with acute shunt thrombosis survived earlier. The average survival time of ECMO was (50.1 ± 12.5) h and that of the deceased (125.2 ± 25.0) h (P = 0.01). The average follow-up of 7/14 early survivors was 20 months (range 2-78 months). Conclusions Based on our experience, ECMO treatment can save one third of the dying children’s lives after I-phase reconstruction. Especially for potentially reversible diseases such as acute shunt thrombosis and transient ventricular dysfunction.