| 摘要: |
| ［摘要］ 目的 分析体外膜肺氧合（ECMO）救治儿童危重症肺炎支原体肺炎（FMPP）的临床疗效及安全性。方法 回顾性分析2017年1月至2019年12月上海市儿童医院重症医学科收治的14例行ECMO救治的FMPP患儿的临床资料。总结患儿的一般资料、临床及影像学特征、机械通气及ECMO初始参数、并发症和预后等临床资料。结果 ECMO救治FMPP患儿14例，年龄中位数为45月龄，其中静脉-动脉ECMO（VA-ECMO）支持8例，静脉-静脉ECMO（VV-ECMO）支持6例。ECMO前发热持续时间中位数为12 d，机械通气时间中位数为65 h，氧合指数（P/F）中位数为62 mmHg，氧指数（OI）中位数为28。ECMO前所有患儿外周血D-二聚体水平均升高，中位数为3.9 mg/L。ECMO运行时间中位数为141 h，11例行连续性肾脏替代治疗。5例患儿出现ECMO相关并发症，其中脑梗死1例，龋齿牙龈处大出血1例，膜氧合器及管路血栓1例，血胸2例。14例患儿中混合感染9例，2例分别因合并人腺病毒感染及继发鲍曼不动杆菌感染导致多脏器功能衰竭死亡。结论 ECMO是救治儿童FMPP心肺衰竭的有效手段，但出凝血并发症发生率高，合并感染可能导致儿童FMPP预后不良。 |
| 关键词: 体外膜肺氧合 危重症肺炎支原体肺炎 难治性低氧性呼吸衰竭 儿童 |
| DOI：10.3969/j.issn.1674-3806.2025.08.03 |
| 分类号: |
| 基金项目:国家重点研发计划课题（编号：2021YFC2701704） |
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| Clinical observation of extracorporeal membrane oxygenation in salvage treatment of fulminant Mycoplasma pneumoniae pneumonia in children |
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ZHOU Yiping, ZHANG Yucai, SHAN Yijun, CHEN Rongxin, SUN Ting, ZHU Guangyao, DOU Jiaying, CUI Yun
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Department of Critical Care Medicine, Shanghai Children′s Hospital(Shanghai Children′s Hospital, Shanghai Jiao Tong University School of Medicine), Shanghai 200062, China
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| Abstract: |
| ［Abstract］ Objective To analyze the clinical efficacy and safety of extracorporeal membrane oxygenation(ECMO) in salvage treatment for children with fulminant Mycoplasma pneumoniae pneumonia(FMPP). Methods A retrospective analysis was conducted on the clinical data of 14 pediatric patients with FMPP who were admitted to Department of Critical Care Medicine of Shanghai Children′s Hospital and were treated with ECMO from January 2017 to December 2019. The pediatric patients′ clinical data including general data, clinical and imaging features, initial parameters of mechanical ventilation and ECMO, complications and prognosis were summarized. Results The salvage treatment with ECMO was performed on the 14 FMPP pediatric patients, with a median age of 45 months. Among them, 8 pediatric patients received veno-arterial ECMO(VA-ECMO) support, and 6 pediatric patients received veno-venous ECMO(VV-ECMO) support. Before ECMO, the median duration of fever was 12 days, and the median duration of mechanical ventilation was 65 hours. The median pre-ECMO oxygenation index(P/F) was 62 mmHg, and the median oxygenation index(OI) was 28. Before ECMO, the D-dimer levels in peripheral blood of all the pediatric patients were elevated, with a median value of 3.9 mg/L. The median running time of ECMO was 141 hours, and 11 pediatric patients underwent continuous renal replacement therapy. Five pediatric patients presented with ECMO-related complications, including 1 case of cerebral infarction, 1 case of heavy bleeding at the gums due to tooth decay, 1 case of membrane oxygenator and pipeline embolization and 2 cases of hemothorax. Among the 14 pediatric patients, 9 pediatric patients had mixed infections. Among them, 2 pediatric patients died of multiple organ failure due to complicating human adenovirus infection and secondary Acinetobacter baumannii infection, respectively. Conclusion ECMO is an effective means in salvage treatment of cardiopulmonary failure in children with FMPP. However, the adoption of ECMO can lead to a high incidence of complications such as bleeding and coagulation in the children, and the complicating infections may result in a poor prognosis for the FMPP children. |
| Key words: Extracorporeal membrane oxygenation(ECMO) Fulminant Mycoplasma pneumoniae pneumonia(FMPP) Refractory hypoxemic respiratory failure Children |
