体外膜式人工氧合法应用于婴儿胎粪吸入综合征:静脉-静脉体外膜式氧合法10年的经验

作     者：Kugelman A. Gangitano E. Taschuk R. M. Durand 王经纬 

作者机构：LAC- USC Medical Center Women's and Children's Hospital 1240 N. Mission Rd Los Angeles CA 90033 United States 

出 版 物：《世界核心医学期刊文摘（儿科学分册）》 (Dkgest of the World Latest Medical Information)

年 卷 期：2005年第1卷第12期

页      面：48-49页

学科分类：1002[医学-临床医学] 100202[医学-儿科学] 10[医学] 

主　　题：胎粪吸入综合征 体外膜式氧合 膜式 表面活性物质 法应 平均气道压 呼吸衰竭 颅内合并症 动脉氧分压 套管插入术 

摘      要：Despite the emergence of new therapies for respiratory failure of the newborn with meconium aspiration syndrome (MAS), extracorporeal membrane oxygenation (ECMO) has a significant role as a rescue modality in these infants. Our objective was to compare the use of venovenous (VV) vs venoarterial (VA) ECMO in newborns with MAS who need ECMO and to ascertain the impact of new therapies in these infants during the last decade. We also evaluated how disease severity or time of ECMO initiation affected mortality and morbidity. Methods: A report of 12 years experience (1990- 2002) of a single center, comparing VV and VA ECMO, is given. Venovenous ECMO was the preferred rescuemodality for respiratory failure unresponsive to maximal medical therapy. Venoarterial ECMO was used only when the placement of a VV ECMO 14- F catheter was not possible; 128 patients met ECMO criteria, 114 were treated with VV ECMO, and 12 with VA ECMO. Two patients were converted from VV to VA ECMO. Results: Venovenous and VA ECMO patients had comparable birth weight (mean ± SEM, 3.48 ± 0.05 vs 3.35 ± 0.15 kg) and gestational age (40.3 ± 0.1 vs 40.7 ± 0.3 weeks). Before ECMO, there was no difference between VV and VA ECMO patients in oxygenation index (60 ± 3 vs 63 ± 8), mean airway pressure (19.5 ± 0.4 vs 20.8 ± 1.5 cm H2O), alveolar-arterial O2 gradient (630 ± 2 vs 632 ± 4 torr), ECMO cannulation age (median [25th- 75th percentiles], 23 [14- 47] vs 26 [14- 123] hours),or in the % of patients who needed vasopressors/ inotropes (98% vs 100% ). From November 1994, inhaled nitric oxide (NO) was available. Before VV ECMO, 67% of the patients received NO, 24% received surfactant, and 48% were treated with high-frequency ventilation (HFV). There was no significant difference bet-ween VV and VA ECMO patients in survival rate (94% vs 92% ), ECMO duration (88 [64- 116] vs 94 [55- 130] hours), time of extubation (9 [7- 11] vs 14 [9- 15] days), age at discharge (23 [18- 30] vs 27 [15- 41] days), or incidence o