体外膜氧合后颅内出血的治疗:1例报告并文献复习

Q4 Medicine

中华小儿外科杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2020.01.008

Yi Zhang, Ji-cui Zheng, R. Zhao, W. Shi, Weiming Chen, G. Lu, Hao Li

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引用次数: 0

摘要

目的探讨儿童体外膜氧合(ECMO)后颅内出血的诊断、治疗及预后。方法回顾性分析2011 ~ 2018年ECMO合并颅内出血89例患者的临床资料。收集并分析患者的临床资料。6例患儿(6.7%)在ECMO治疗期间出现颅内出血。颅内出血6例，男4例，女2例，年龄1 ~ 11岁。病因为心肌炎(n=1)和重症肺炎(n=5)。2例需要ECMO院外置管。ECMO平均持续时间为126.8(28.0 ~ 229.5)小时。结果ct检查瞳孔大小不等(n=2)， MRI检查偏瘫(n=1)，常规b超检查(n=2)， MRI检查颅内出血(n=1)。病变部位为硬膜下(n=1)、脑组织深部(n=1)和脑叶(n=4)。干预措施为手术(n=2)、保守措施(n=2)和放弃治疗后死亡(n=2)。手术患儿GOS评分为5分(硬膜外出血)和4分(偏瘫)。结论颅内出血是ECMO术后严重的出血并发症。早期诊断和手术治疗可改善其预后。关键词:颅内出血;体外膜氧合;外科处置

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Treatments of intracranial hemorrhage after extracorporeal membrane oxygenation: case report and literature review

Objective To explore the diagnosis, treatment and prognosis of intracranial hemorrhage after extracorporeal membrane oxygenation (ECMO) in children. Methods Retrospective analysis was performed for 89 ECMO cases with intracranial hemorrhage from 2011 to 2018. Their clinical data were collected and analyzed.Six children (6.7%) had intracranial hemorrhage during ECMO treatment. Among 6 cases of intracranial hemorrhage, there were 4 boys and 2 girls with an age range from 1 day to 11 years. The causes were myocarditis (n=1) and severe pneumonia (n=5). Two cases required ECMO out-hospital catheterization. The average ECMO duration was 126.8(28.0-229.5) hours. Results Computed tomography was examined for unequal pupils (n=2), magnetic resonance imaging (MRI) for hemiplegia (n=1), B-mode ultrasound for routine uses (n=2) and MRI for intracranial hemorrhage (n=1). The locations of lesion were subdural (n=1), deep brain tissue (n=1) and brain lobe (n=4). The interventions were surgery (n=2), conservative measures (n=2) and death after giving up treatments (n=2). GOS score of surgical children was 5 points (epidural hemorrhage) and 4 points (hemiparesis). Conclusions Intracranial hemorrhage is a severe hemorrhagic complication after ECMO. Early diagnosis and surgical treatment may improve its prognosis. Key words: Intracranial hemorrhages; Extracorporeal membrane oxygenation; Surgical treatment

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.