摘要目的 探索体外膜氧合技术(ECMO)抢救儿童危重症合并严重心肺功能衰竭的经验和并发症发生情况.方法 总结2015年12月至2017年8月,上海交通大学附属儿童医院接受ECMO治疗的17例非心脏手术合并心肺功能衰竭患儿资料,其中男9例、女8例,中位年龄24(2,117)月;中位体质量12(5,33) kg.ECMO支持时机是传统治疗无效的心血管功能衰竭和肺保护性通气无效的重度急性呼吸窘迫综合征(ARDS).采用右侧颈内动静脉置管,V-A ECMO支持模式.结果 17例患儿接受ECMO支持平均治疗时间212.5h,中位数188.5 h(3～924 h).全部病例同时采用呼吸机保持肺复张,10例(58.8％)联合床旁连续性血液净化(CRRT)协助管理液体平衡.11例(64.7％)患儿成功撤离ECMO(撤离24h存活),10例(58.8％)存活出院,其中2例ECPR存活1例.ECMO运行期间共发生41例次并发症,以压疮(64.7％)、血小板减少(52.9％)、出血(35.3％)为主.结论 本组常规治疗无效的心肺功能衰竭ECMO支持出院成活率58.8％,说明儿童ECMO支持是一项重要的救治技术.

abstractsObjective To summarize the therapeutic effects of extracorporeal membrane oxygenation (ECMO) on critically ill children with severe cardiopulmonary failure.Methods The pediatric patients supported with ECMO admitted to pediatric intensive care unit (PICU) from December 2015 to August 2017 were enrolled in this study.The data of demographics of patients,diagnosis,indication for ECMO,the procedure of ECMO support,complications,and survival status were analyzed.Results A total of 17 pediatric patients including 9 male and 8 female with severe cardiopulmonary failure treated with ECMO were studied.The median of age was 24 (2,117) months,and the median of body weight was 12 (5,33) kg.The indications for initiation of ECMO were cardiovascular failure with poor response to conventional therapy and severe acute respiratory distress syndrome (ARDS) without any beneficial effect obtained from mechanical ventilation.The percutaneous cannulation was done under ultrasound guidance by a team of trained intensivists through right cervical vein and internal carotid artery resulting in veno-arterial extracorporeal membrane oxygenation support.The mean duration of ECMO support was 212.5 h with median 188.5 (3-924) h.All patients were treated with mechanical ventilation for prevention from pulmonary atelectasis.Of 17 patients,10 were coupled with continuous renal replacement therapy (CRRT) to keep fluid balance.As a result,11 children (64.7％) were successfully weaned from ECMO defined as survival for 24 h after ECMO,and 10 children (58.8％) were alive to discharge from hospital.One of 2 cardiac arrest cases treated with extracorporeal cardiopulmonary resuscitation (ECPR) was alive.During ECMO support,there were 41 adverse events happened including pressure ulcers (64.7％),thrombocytopenia (52.9％),bleeding (35.3％).Conclusions The survival rate at discharge was 58.8％ in pediatric patients with severe cardiopulmonary failure with poor response to conventional therapy.Our data suggest that ECMO support is an important rescue technique for pediatric critical illness.