The Rescue of Acute Fulminant Myocarditis by Extracorporeal Membrane Oxygenation in Pediatric Patients

以體外膜性氧化器拯救急性猛暴性心肌炎之病童

林建亨(Chien-Heng Lin) ； 張正成(Jeng-Sheng Chang) ； 李秉純(Ping-Chun Li)

《Acta Paediatrica Taiwanica》 46卷4期 (2005/08) Pp. 201-205

https://doi.org/10.7097/APT.200508.0201

摘要

急性心肌炎的表現可以是從無明顯的症狀到嚴重導致死亡。若是猛暴性心肌炎的話，當發生休克時其死亡率可高達75%。體外膜性氧化器在近幾年來已被應用來拯救此類猛暴性心肌炎的病患。近三年來本院有六位這樣的小兒科病患以此種來方式處理。回顧病歷記載，有六位猛暴性心肌炎的小兒科病患使用體外膜性氧化器來拯救；其中五位病患使用股動靜脈體外膜性氧化器，另外一位則使用右心房左心房動脈體外膜性氧化器。其年齡中位數為12歲（9歲至14歲），使用體外膜性氧化器時間中位數為61.5小時（從36小時至90小時）。全部存活率為50%，但其中有2位有深部靜脈栓塞及周邊神經病變的併發症。所有存活者經平均1.8年追蹤後（從0.8年至4.3年）其心臟功能皆恢復正常。我們的結論是：及早預知疾病惡化及緊急建立體外膜性氧化器是拯救猛暴性心肌炎的關鍵，而且要儘可能來避免使用體外膜性氧化器所發生的併發症。

關鍵字

猛暴性心肌炎 ； 體外膜性氧化器 ； 深部靜脈栓塞

並列摘要

The severity of acute myocarditis varies between subclinical to lethal. For fulminant myocarditis, the mortality rate can be as high as 75% when shock occurs. Extracorporeal membrane oxygenation (ECMO) support to revert this fulminant course has been introduced into the management in recent years. Six such pediatric cases rescued with ECMO in our hospital over a 3-year period were reviewed. Femoral venoarterial cannulated ECMO was undertaken in 5 patients and right atrium and ascending aorta cannulated ECMO in one. All patients had histories and clinical findings consistent with fulminant myocarditis. Median age was 12 years old (range 9 to 14 years). Median duration of ECMO support was 61.5 hours (range 36 to 90 hours). Three patients survived. Two of them complicated with deep vein thrombosis or peripheral neuropathy. The survivors showed normal cardiac function after follow-up periods of 0.8-4.3 years. Early recognition and immediate establishment of an ECMO circuit are crucial to rescue a patient with fulminant myocarditis. Every effort to avoid the complications associated with ECMO should then be stressed.

並列關鍵字

fulminant myocarditis ； extracorporeal membrane oxygenation ； deep vein thrombosis