超声在监测体外膜肺治疗儿童急性暴发性心肌炎的应用价值

目的探讨超声在体外膜肺氧合(ECMO)治疗儿童急性暴发性心肌炎中的应用价值。方法选取我中心收治的21例因急性暴发性心肌炎行ECMO治疗并成功脱机的患儿,观察ECMO治疗前和ECMO撤离即刻各超声心动图参数的变化,并监测并发症发生情况。结果21例患儿治疗前的超声心动图表现:17例出现左室壁增厚,心肌回声减低;12例出现少量心包积液;16例出现二、三尖瓣少量反流。与ECMO治疗前比较,ECMO撤离即刻左室射血分数、二尖瓣前叶收缩期运动速度、左室流出道速度时间积分均升高,左室壁厚度、左室舒张末期内径、左房内径均减小,肺动脉收缩压下降,差异均有统计学意义(均P<0.01)。发生的并发症包括:静脉插管位置不当3例,插管位置渗血5例,颈动脉插管处假性动脉瘤1例,插管于右房入口血栓1例,脑组织损伤1例。结论超声可在急性暴发性心肌炎的诊断、ECMO治疗过程中评估心脏功能的变化及监测并发症的发生,具有重要的应用价值。

Application of Ultrasound monitor in extracorporeal membrane oxygenation therapy in chidren with acute fulminant myocarditis

Objective: To investigate the application value of Ultrasound after Extracorporeal Membrane Oxygenation(ECMO)in patients with Acute fulminant myocerditis (AFM). Methods: 21 patients were admitted in PLA General hospital seventh medical center from January 2017 to November 2021. All patients accepted with Veno-arterial extracorporeal membrane Oxygenation(ECMO), complications associated with ECOMO and clinical outcome were documented. Ultrasound were performed before and during period of treatment. Results echocardiography parameter after ECMO implantation including left ventricular ejection fraction (LVEF). Left ventricular outflow tract velocity time integral(LVOT VTI), Tissue Doppler Imagine of anterior mitral leaflet(AMV DTI)increased significantly (p<0.01) , while Left ventricular diastolic diameter(LVDD), Left atrial diameter(LAD),Left ventricular wall thickness(LVWT), Pulmonary aterial pressure decreased (p<0.01),there was no difference in Right ventricular diastolic diameter (RVDD). Conclusion: Ultrasound can make an irreplaceable in diagnosis of AFM and can monitor its cardiac function effectively.