超过30年的新生儿呼吸系统外体膜氧化
Ari R Joffe1, Lauren Ryan1, Laurance Lequier1
1From the Department of Pediatrics, Division of Pediatric Critical Care Medicine, University of Alberta, Edmonton, Alberta, Canada.
ASAIO journal (American Society for Artificial Internal Organs : 1992)
|September 5, 2025
概括
新生儿呼吸器外体膜氧化 (ECMO) 没有改善34岁以上的生存或神经认知结果. 虽然先天性隔膜会影响结果,但感觉神经听力损失被排除了.
科学领域:
- 儿童重症监护医疗
- 新生儿神经学
- 发展性儿科
背景情况:
- 外体膜氧化 (ECMO) 是重度呼吸衰竭的新生儿的生命支持技术.
- 新生儿ECMO后的长期神经发育结果对于评估治疗疗效和患者健康至关重要.
- 随着时间的推移,ECMO实践和患者群体的变化可能会影响结果.
研究的目的:
- 评估34年内新生儿呼吸ECMO治疗儿童的生存和神经认知结果的趋势.
- 确定与最佳结果相关的因素,包括特定的诊断和ECMO管理策略.
- 评估患者人口结构和治疗方案对长期神经发育后果的影响.
主要方法:
- 包括232名接受呼吸ECMO的新生儿在内的两个时代 (1989-2000年和2000-2022年) 的前性开始队列研究.
- 幼儿园年龄的神经认知评估 (智力,视觉运动整合) 和感官运动残疾评估.
- 统计分析以确定年龄,诊断 (例如,先天性隔膜),ECMO参数和结果之间的关联.
主要成果:
- 总体生存率和神经认知结果 (全尺度智商,口头智商,性能智商,视觉运动整合) 在两个时代之间没有显著变化.
- 53%的幸存者患有残疾,只有38%的人取得了最佳结果 (得分≥80且没有残疾).
- 先天性隔膜独立地与较差的神经认知结果有关,而感觉神经听力损失在后期被消除.
结论:
- 尽管新生儿护理和ECMO技术取得了进展,但需要呼吸ECMO的新生儿的长期神经发育结果仍然是一个重大问题.
- 早期识别和管理风险因素,如先天性隔膜,对于改善神经认知轨迹至关重要.
- 在晚期消除神经感官听力损失表明在治疗或患者选择方面可能有所改善,因此需要进一步调查.
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