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目的评价体外膜式氧合(extracorporeal membrane oxygenation,ECMO)支持在婴幼儿大动脉错位(TGA)患者大动脉转位术(ASO)后心室功能恢复和适应性训练的临床结果及可行性。方法 2005年1月至2008年8月,北京阜外心血管病医院7例TGA患者接受ASO后需要ECMO支持,其中男3例,女4例;年龄3周~14个月。ASO后心室不能适应新的血流动力学和/或合并心功能受损,采用静脉-动脉-ECMO辅助,占同期小儿先天性心脏病患者术后应用ECMO的36.84%(7/19)。插管途径为经胸右心房引流,升主动脉灌注;采用ECMO系统为:Biomedicu(Medtronic)4例,Jostra 2例,Medos 1例;辅助流量20~100 ml/kg。结果 7例患者平均转流时间174h(64~266 h),心室训练时间平均96 h。4例成功脱离ECMO,脱机率57.14%(4/7);3例出院。死亡4例,其中3例不能脱离ECMO直接死亡,死亡原因为肾功能衰竭1例,出血1例,多器官功能衰竭1例;1例在脱离ECMO后6 d感染死亡。结论 ECMO能为TGA患者ASO后心功能的恢复和左心室适应性训练提供有效的支持。
Objective To evaluate the clinical results and feasibility of extracorporeal membrane oxygenation (ECMO) in support of ventricular function recovery and adaptive training in patients with infantile aortic transposition (TGA) after aortic transposition (ASO). Methods From January 2005 to August 2008, 7 patients with TGA in Beijing Fuwai Hospital received ECMO support after ASO, including 3 males and 4 females, ranging in age from 3 weeks to 14 months. After ASO, the ventricles could not adapt to the new hemodynamics and / or impaired cardiac function. The use of veno-arterial-ECMO supplementation accounted for 36.84% (7/19) of ECMO in children with congenital heart disease during the same period. Intubation through the right atrium drainage, ascending aorta perfusion; using ECMO system: Biomedicu (Medtronic) in 4 cases, Jostra 2 cases, Medos 1 case; auxiliary flow 20 ~ 100 ml / kg. Results The mean transit time of seven patients was 174 h (64 ~ 266 h), and the average time of ventricle training was 96 h. Four patients were successfully separated from ECMO. The off-rate was 57.14% (4/7) and three patients were discharged. 4 died, of which 3 died of ECMO. The cause of death was 1 case of renal failure, 1 case of bleeding and 1 case of multiple organ failure. One case died of infection 6 days after ECMO. Conclusion ECMO can provide effective support for the recovery of cardiac function and left ventricular adaptive training after ASO in TGA patients.