Table of Contents

HK J Paediatr (New Series)
Vol 20. No. 3, 2015

HK J Paediatr (New Series) 2015;20:151-155

Original Article

Extracorporeal Membrane Oxygenation Therapy in Children with Acute Fulminant Myocarditis

HQ Zhou, B Chen, BT Ning, HY Zhang


Objective: Acute fulminant myocarditis is a serious and rapidly progressive condition, when aggressive medical support is ineffective, extracorporeal membrane oxygenation (ECMO) support is considered the most effective option in adult. In order to observe the clinical effect and nursing of ECMO in children with acute fulminant myocarditis, we performed the following study. Methods and patients: Seven children with acute fulminant myocarditis, who were hospitalised at the Children's Hospital Intensive Care Unit, School of Medicine, Zhejiang University and received ECMO adjuvant therapy from February 2009 to July 2014, were analysed. Results: Six of seven patients were successfully weaned from ECMO treatment after 40-142 hours and discharged from the hospital; one patient died because of continued cardiac dysfunction and multiple organ failure. The total survival rate was 85.71% (6/7). The heart rate, blood pressure, and oxygen saturation significantly improved after initiating ECMO. During ECMO, wound haemorrhage was the most common complication result in 85.71% (6/7). Acute renal failure and haemorrhage secondary to haemolysis was observed in one patient, and hyperglycaemia happened in one patient. During the follow-up period lasting for 3 months to 5 years and 3 months, cardiac function recovered normally in the six surviving children. Conclusion: Clinical ECMO application provides effective support for the treatment of acute fulminant myocarditis in children. Timely intervention, thorough assessment and close monitoring based on nursing care, and complication prevention are the keys to ensuring successful ECMO treatment.

目的:急性爆發性心肌炎是一種嚴重和急速惡化的疾病。當積極醫療無效時,體外膜肺氧合(ECMO)療法為醫治成年患者的最有效方法。為觀察急性爆發性心肌炎兒童的ECMO的臨床效果和護理,我們進行以下研究。方法和病人:對2009年2月至2014年7月浙江大學醫學院兒童醫院重症治療部住院,接受ECMO輔助治療的急性爆發性心肌炎患兒7人進行分析。結果:7名患兒中,6人在ECMO治療40-142小時後不用使用有關儀器並出院,1人死於持續心臟功能障礙和多器官衰竭,總體生存率為85.71%(6 / 7)。ECMO啟用後,心率、血壓和氧飽和度明顯改善。ECMO治療期間,傷口出血為最常見併發症,達85.71%(6 / 7)。1人出現急性腎功能衰竭和溶血後出血,高血糖1人。追蹤期持續至3個月至5年3個月,6名存活兒童的心功能恢復正常。結論:臨床ECMO應用頗能有效治療急性爆發性心肌炎的兒童。適時應用、通過護理方面的評估和密切監護,以及併發症預防是實現ECMO治療成功的關鍵。

Keyword : Acute fulminant myocarditis; Children; Extracorporeal membrane oxygenation (ECMO)



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