中国实用儿科杂志

中国实用儿科杂志 ›› 2023, Vol. 38 ›› Issue (8): 619-624.DOI: 10.19538/j.ek2023080613

• 论著 • 上一篇    下一篇

经颈部插管儿科体外膜氧合后脑成像异常的危险因素分析

  

  1. 1.南方医科大学第二临床医学院，广东 广州510515；2.中国人民解放军总医院第七医学中心，北京 100700；3.河南省人民医院，河南 郑州450003；4.郑州大学附属儿童医院，河南 郑州 450053 冯秋霜与刘昌峨对本文有同等贡献，均为共同第一作者
  • 出版日期:2023-08-06 发布日期:2023-08-29
  • 通讯作者: 洪小杨，电子信箱：jyhongxy@163.com
  • 基金资助:
    国家重点研发计划（2021YFC2701700）；首都卫生发展科研专项面上项目（2020-2-5093）

Risk factors of brain imaging abnormalities  in pediatric patients supported by extracorporeal membrane oxygenation with cervical vessels cannulation

  1. *The Second School of Clinical Medicine，Southern Medical University，Guangzhou 510515，China
  • Online:2023-08-06 Published:2023-08-29

摘要： 目的    探讨经右侧颈部插管的体外膜氧合（ECMO）患儿出现脑成像异常的危险因素。方法    回顾性分析多中心2016年1月至2021年12月期间于中国人民解放军总医院第七医学中心儿科医学部、河南省人民医院、河南省儿童医院行经右侧颈内静脉、颈总动脉插管建立动脉-静脉ECMO（VA-ECMO）支持并存活的患儿资料。根据头颅计算机断层扫描或磁共振成像信息分为异常组和正常组，分析患儿人口统计学资料、ECMO前后实验室检查以及处理，并将单因素分析中有统计学意义变量纳入到多因素Logistic回归中，分析ECMO相关急性脑影像学异常的独立危险因素。结果    共纳入患儿108例，其中正常组47例，异常组61例，ECMO后患儿头颅影像学异常率为56.48%。108例患儿中，ECMO后右侧颈总动脉结扎率37.04%（n=40），修复率62.96%（n=68）。结扎者脑成像异常率62.50%（25/40），修复者52.94%（36/40），但二者差异无统计学意义（P>0.05）。患儿类型（新生儿或儿童）、性别、体重、ECMO前诊断等基本资料差异无统计学意义（P>0.05）。ECMO前pH值、碱剩余及乳酸与正常组比较，差异具有统计学意义（P<0.05）。异常组ECMO前乳酸值高于正常组（P=0.003），并与脑成像异常间存在正向相关关系（OR=1.107）。结论    该研究结果提示ECMO前乳酸堆积是急性脑成像异常发生的独立危险因素，ECMO撤离后右侧颈总动脉结扎与脑影像学异常无显著相关。

关键词: 体外膜氧合, 儿科, 神经成像, 危险因素

Abstract: Objective    To explore the risk factors of brain imaging abnormalities in children with ECMO who are intubated through the right neck. Methods    A retrospective analysis was performed on the data of children who underwent VA-ECMO support and survived by cannulation of the right internal jugular vein and common carotid artery from January 2016 to December 2021. According to the head CT/MRI information，they were divided into an abnormal group and a normal group. The demographic data，ECMO-related laboratory tests，and treatment were analyzed. The variables with statistical significance in the univariate analysis were included in the multivariate logistic regression to analyze the independent risk factors for ECMO-related acute brain imagng abnormalities. Results    A total of 108 children were included. There were 47 cases in the normal group and 61 cases in the abnormal group，with a brain CT/MRI abnormality rate of 56.48%. After ECMO，the right common carotid artery ligation rate was 37.04% （n=40）in the 108 cases，and the repair rate was 62.96% （n=68）. The rate of brain imaging abnormalities in carotid artery ligation was 62.50% （n=25），and that of repairers was 52.94% （n=36）， but there was no significant difference between the two （P>0.05）. There was no significant difference in the basic data such as type （neonatal/child），gender，weight，or pre-ECMO diagnosis （P>0.05）.  The pH value， base excess and lactate value before ECMO  were significantly different from those in the normal group（P<0.05）. The lactate value before ECMO in the abnormal group was significantly higher than that in the normal group （P = 0.003），which a significant positive correlation with brain imaging abnormalities （OR=1.107）. Conclusion    Lactic acid accumulation before ECMO is an independent risk factor for brain imaging abnormalities，and right common carotid artery ligation after ECMO withdrawal is not significantly associated with brain imaging abnormalities.

Key words: extracorporeal membrane oxygenation, pediatric, nerve imaging , risk factors