Objective·To analyze the neurodevelopmental outcomes of children after end-to-side anastomosis for coarctation of the aorta (CoA).Methods·The surgical and neurological follow-up data were collected from children who underwent end-to-side anastomosis for CoA at Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine from January 1, 2017 to December 31, 2021. Neurological assessments included magnetic resonance imaging (MRI) and Griffiths Mental Development Scale assessments. Neurodevelopmental outcomes were evaluated using Griffiths Mental Development Scale. Clinical characteristics were compared between patients with normal and abnormal MRI and Griffiths Mental Development Scale results to assess the correlation between the two assessments and their association with cardiopulmonary bypass (CPB) use and CPB modality.Results·Twenty-seven children with isolated CoA or CoA combined with simple intracardiac anomalies were included. MRI results were available for 25 cases, with 5 showing abnormalities (20.0%). Griffiths Mental Development Scale results were available for 26 cases, with 21 (80.77%) showing abnormal scores, including 18 in hearing and language, and 12 in performance. No significant correlation was found between abnormal MRI or Griffiths Mental Development Scale results and the use of CPB (P=0.341, P=1.000). Among patients who underwent CPB, those in the moderate hypothermia group accounted for the majority of cases without neurological abnormalities, with proportions of 80.00% (MRI) and 100.00% (Griffiths Mental Development Scale).Conclusion·Children undergone end-to-side anastomosis for CoA are at relatively high risk for neurodevelopmental abnormalities, particularly in hearing-language and performance domains. CPB may not be a direct risk factor for poor neurodevelopmental outcome, and moderate hypothermia during CPB may be neuroprotective.

Mesenchymal stem cell therapy involves the secretion of various factors to regulate the local microenvironment in various of diseases. This therapy offers hope for treating acute myocardial infarction (MI), which poses a serious threat to human health. However, challenges such as low paracrine efficiency and poor cell survival persist due to the harsh post-infarction conditions, such as hypoxia. Recently, enhanced cell therapy, in which vascular endothelial growth factor A (VEGFA) and basic fibroblast growth factor (bFGF) are used as therapeutic agents to limit myocardial injury and simultaneously induce neovascularisation, has been recognised as a promising new strategy to improve the efficacy of cell therapy. Chemically synthetic modified messenger RNA (modRNA), a novel protein expression technology, enables safe, rapid, efficient and pulsatile expression of target proteins in vivo and in vitro settings. It has been widely applied in the fields of vaccine research and tissue regeneration. In this study, human adipose-derived stem cells (hADSCs) were transfected with VEGFA and bFGF modRNA to transiently overexpress these proteins before transplantation. This modification enhanced the paracrine effect of transplanted hADSCs and promoted stability in the vascular network at the transplantation site. Overexpression of VEGFA and bFGF in hADSCs not only inhibited apoptosis but also reduced ventricular remodelling and improved cardiac function and left ventricular conduction. Overall, the additive effects of VEGFA modRNA, bFGF modRNA and hADSCs hold promise for comprehensive cardiac repair post-MI and show substantial potential for treating ischemic heart diseases. KEY POINTS: ModRNAs-transfected hADSCs exhibit pulsed and transient expression, enabling efficient production of functional VEGFA and bFGF proteins. Intracardiac injection of these engineered hADSCs leads to the enhancement of cardiac function and the improvement of electrical conduction. The hADSCsdual mainly exerts its effect on myocardial infarction by promoting stable vascular regeneration and suppressing cell apoptosis.

Abstract Background Total anomalous pulmonary venous connection (TAPVC) is a rare congenital cardiac defect with high mortality rates, ranging from 9–30%. Surgical repair is the primary treatment, but postoperative complications such as arrhythmias, pulmonary hypertension, and pulmonary vein obstruction persist. Extracorporeal membrane oxygenation (ECMO) has emerged as a critical tool for managing complex cardiac cases, including TAPVC. Methods This retrospective study analyzed patients who received ECMO support postoperatively for TAPVC at Shanghai Children's Medical Center between January 2017 and December 2021. Inclusion criteria were children diagnosed with TAPVC and treated with ECMO. Data on demographics, surgical procedures, ECMO duration, complications, and outcomes were collected. The study followed the Helsinki Declaration. Results A total of 14 TAPVC patients were included, with a median age of 89.5 days and weight of 4.95 kg. The ECMO weaning rate was 85.71%, and the survival rate was 50%. The weaning and survival rates for intracardiac TAPVC were better than other subtypes. Further grouped showed that the high lactate status before ECMO (p = 0.00031) and the fluctuation of APTT value (p = 0.0011) during the ECMO period had predictive significance for the long-term prognosis of these children. Conclusion ECMO support is an effective therapy for TAPVC patients facing postoperative complications. Higher pre-ECMO lactate levels and fluctuations in APTT values during ECMO were predictive of long-term prognosis.

OBJECTIVES:To analyze the clinical outcomes of extracorporeal membrane oxygenation (ECMO) support in children with congenital heart disease (CHD) after surgery and explore the risk factors associated with mortality during long-term follow-up for 3-5 years. METHODS:We conducted a retrospective observational study at Shanghai Children Medical Center (SCMC) from 2017 to 2021 and reviewed the clinical results and laboratory findings of 188 CHD patients who received ECMO support during this period. RESULTS:The 5-year overall survival rate was 56.38% (106/188) among CHD patients who received ECMO support. Kaplan-Meier curve showed residual anatomical malformation (RAM) (p < 0.0001), gastrointestinal bleeding (p = 0.019), single ventricular (SV) (p = 0.028), and pre-ECMO lactate level >10 mmol/L (p < 0.0001) were significantly associated with higher mortality in follow-up. Cox analysis identified RAM (p = 0.039) and pre-ECMO lactate level >10 mmol/L (p < 0.001) as independent risk factors for overall survival. Conversely, a minimum platelet count ≥50 × 109/L (p < 0.001) was found to be a protective factor. Moreover, a competing risk model showed that a CPR time ≥60 min (p < 0.001) was identified as a risk factor for death in patients who failed to be discharged from the hospital. CONCLUSIONS:Our study showed characteristics of long-term follow-up patients and revealed several risk factors associated with mortality in children with CHD who received ECMO support. These findings can provide valuable insights for clinical decision-making and contribute to improving patient outcomes.

Objective:To summarize the outcomes of neurologic development disorders after surgery with selective cerebral perfusion (SCP) in children of aortic arch malformations (including coarctation of aorta & interruption of aortic arch).Methods:From May 2019 to June 2021, the relevant clinical data were retrospectively reviewed for 58 children operated for aortic arch malformation.According to whether or not SCP was applied, they were assigned into two groups of SCP (n=22) and circulatory arrest (n=11). Basic profiles of age, gender, weight, clinical manifestations, hospitalization stay, intraoperative bypass duration, aortic occlusion duration, postoperative blood levels of lactate & procalcitonin and postoperative complications were retrospectively reviewed.Thirty-three of them underwent cranial magnetic resonance imaging (MRI). Griffiths mental development assessment score (GDS-C) was assessed at 1 year postoperatively.It was expressed as developmental quotient (DQ). DQ values between two groups were compared by independent t-test.Results:There were 34 boys and 24 girls with an age range of (1-2 052) day.They were followed up for 1 to 3 years after discharge and weighting from 2.5 to 21.4 kg.Postoperative lactate value was (2.41±1.08) mmol/l and (3.19±1.22) mmol/l in SCP and circulatory arrest groups respectively ( P<0.05). GDS-C test results indicated that average DQ scores of hand-eye coordination energy area was (94.51±14.53) and (81.95±18.16) in SCP and circulatory arrest groups respectively ( P<0.05). However, scores of DQ in sports, personal-social, hearing and language areas were higher in SCP group than those in circulatory arrest group.The differences were not statistically significant.The percentage of individuals with DQ ≥70 in hearing and language areas was equal in two groups.However, percentage ratio in other areas was higher in SCP group than that in circulatory arrest group. Conclusions:Mild hypothermia with SCP may be applied with fewer neurological complications.As a feasible, safe and effective cerebral protection measure, SCP provides effective cerebral perfusion and reduces the risk of central nervous system complications due to cerebral ischemia of traditional arch surgery in children.

Artificial skin substitutes are one of the most promising areas of wound healing research; however, graft survival largely depends on how the treatment is performed. Early angiogenesis is essential for wound healing and graft survival and vascular endothelial growth factor A (VEGFA) is an important cytokine that stimulates angiogenesis. Here, we first investigated the effects of different ratios of collagen (BC) and gelatin blended with poly (L-lactideco-caprolactone) (PLCL) on nanofibrous membranes. The Young's modulus and cell proliferation were significantly higher in the 50% BC group than that in all other groups. Then, cellular electrospun membrane complexes (CEMC) were successfully constructed from nanoscaffolds and fibroblasts extracted from human foreskin and engineered with controlled autocrine VEGFA by transfecting VEGFA modified mRNA (modRNA). Engineered CEMC significantly promoted wound healing in vivo and contributed to stable vascular network formation in the grafted area, thereby increasing the survival rate of the engineered skin. This study provides a potential solution for wound healing while establishing the value of different RNA modification methods for various engineered skins in the future, thereby advancing engineered skin development.

目的 分析先天性心脏病(CHD)患儿行机械辅助术后早期连续两年的神经行为发育随访研究.方法 2019年对本院2013年1月至2018年12月因CHD纠治术后循环衰竭行机械辅助存活的45例患儿进行筛选,符合随访条件(≤8岁)的为24例,随访内容包括连续两年的头颅核磁共振(MRI)、Griffiths神经行为发育评估.结果 符合连续两年至本院完成随访项目的患儿17例,随访率70.8％.第一次头颅MRI评分为(1.594±0.953)分,第二次头颅MRI影像学表现较第一次有改善的为8例(47.06％),平均得分为(0.906±1.004)分,改善明显(P=0.050).患儿Griffiths神经行为发育评估结果为,不同领域所处的百分位数普遍处于均值至均值减一个标准差的范围内,D领域即手眼协调能力,患儿表现出随年龄增长进一步落后的趋势,具有统计学差异(P=0.031).第一次评估时,患儿在A运动领域和C语言领域,距正常月龄的月龄差距最大,分别为(-6.09±11.54)月和(-4.62±7.01)月.第二次评估时表现为C语言领域和D手眼协调能力上的落后更为显著,分别为(-4.41±9.57)月和(-4.78±7.51)月.尚未能发现影像学图像的异常与神经行为发育近期结果之间存在相关性.当头颅MRI结果较差时(≥2分时),患儿在E表现领域,即视觉空间能力,工作速度及准确性方面明显落后,百分位处于(23.00±16.05)％(P=0.034).结论 儿童心脏术后行机械辅助后的神经行为发育落后具有发病率高以及"成长性疾病"的特点,应尽早建立系统、连续、紧密的术后随访体系,发现问题,积极干预,以期提高患儿及其家庭的生存质量.

OBJECTIVE:To analyze the risk factors for gastrointestinal (GI) bleeding in congenital heart disease (CHD) patients supported with venoarterial extracorporeal membrane oxygenation (V-A ECMO) after open-heart surgery.METHODS:A retrospective analysis was performed on children with (GI group: 26 cases) and without (control group: 122 cases) GI bleeding during ECMO at Shanghai Children's Medical Center from 2017 to 2020. Clinical data were analyzed and compared between groups to search for risk factors for GI bleeding.RESULTS:A total of 148 cases were included in the study. The overall incidence of GI bleeding was 17.6% (26/148). The in-hospital mortality rate in the GI group was 61.5% (16/26) versus 45.9% (56/122) in the control group. Twenty-six patients suffered cardiac arrest before ECMO support. The GI bleeding incidence among extracorporeal cardiopulmonary resuscitation (ECPR) patients was 50.0% (13/26) versus 28.7 (35/122) among non-ECPR patients, p = 0.035. The activated clotting time (ACT) was 201.40 s (180.47 to 247.27) in the GI group versus 177.63 s (167.79 to 203.13) (p = 0.050) in the control group. The lowest antithrombin level (Min AT) was 27.00 ± 13.07% versus 37.62 ± 15.18 (p = 0.001). The pH and lactate levels before ECMO (Pre PH and Pre Lac) were lower in the GI group than in the control group. (7.31 ± 0.23 vs. 7.35 ± 0.17, p = 0.035 and 12.2 ± 6.11 vs. 7.78 ± 6.67, p = 0.003). Liver function during ECMO support was statistically worse in the GI group than in the control group. Multivariate analysis showed that Pre Lac (OR = 1.106 [1.018-1.202], p = 0.0016) was an independent risk factor for GI bleeding. ROC analysis of Pre Lac and GI bleeding showed an area under the curve (AUC) of 0.700 (95% CI: 0.600-0.800, p = 0.002) and a cutoff value of 9.30 mmol/L (sensitivity, 73.1%; specificity, 62.7%).CONCLUSIONS:As the first study in this field, the probability of GI bleeding and related mortality was found to be high in children supported with V-A ECMO after open-heart surgery. A higher lactate level before ECMO was an independent risk factor for GI bleeding.

Objective:To explore the role of extracorporeal membrane oxygenation (ECMO) support in children with complicated congenital heart disease (CHD).Methods:From January 2017 to December 2020, the relevant clinical were retrospectively reviewed for 133 children (76 boys and 57 girls aged 0-18 years) with complex congenital heart disease receiving ECMO-assisted support. The average age at the time of ECMO-assisted support was 4.2 months, the average height (71.33±28.53) cm and the average weight (9.06±11.38) kg. Complex congenital heart diseases requiring ECMO-assisted support included transposition of great arteries (17.29%, 23/133) ,double outlet right ventricle (9.77 %, 13/133) ,pulmonary atresia (9.02 %, 12/133) , valvular disease (8.27 %, 11 /133) and aortic arch interruption & constriction (7.51%, 10/133). G eneral profiles, diagnosis, treatment and examinations were recorded and treatment protocols and outcomes analyzed.Results:Intraoperative cardiopulmonary bypass time was (221.00±161.78) min, blocking duration (100.31±68.09) min, ECMO bypass time (114.87±84.39) h, overall weaning rate of ECMO 63.91 % (85/133) and survival rate of 49.62 % (66/133 ) . Forty-two children underwent extracorporeal cardiopulmonary resuscitation (ECPR) with a weaning rate of 54.76% (23/42) and a survival rate of 40.48% (17/42) . And 48.87% (65/133) of them had ECMO assistance days of 3 to 5 days and the survival rate with this assistance day was 64.62% (42/65) . It was higher than survival rate of those with ECMO support assistance days < 3 days and > 5 days [64.62% (42/65) vs. 22.7(5/22) , 64.62% (42/65) vs. 41.30% (19/46) ] and a difference of 3% had statistical significance ( P<0.05) . Lactate values at 24 h after ECMO showed a relevant trend with weaning ( P=0.036) and survival ( P=0.051) . Common perioperative complications included intracranial hemorrhage and gastrointestinal hemorrhage. Neonatal period was a risk factor for intracranial hemorrhage ( P=0.018) while gastrointestinal hemorrhage was associated with lactate level before assistance ( P=0.013) . Conclusions:ECMO may facilitate the recovery of cardiopulmonary function in postoperative children with complicated CHD. Those with a duration of ECMO 3-5 days have the best overall prognosis. Intracranial hemorrhage is likely to occur with ECMO support during neonatal period. And the pre-ECMO level of lactate is correlated with the occurrence of gastrointestinal hemorrhage.

To analyze the risk factors for intracranial hemorrhage (ICH) in congenital heart disease (CHD) patients supported with venoarterial extracorporeal membrane oxygenation (VA-ECMO). We performed a retrospective analysis of VA ECMO patients after open heart surgery in Shanghai Children’s Medical Center from February 2017 to December 2018, with a total of 50 patients: 14 patients in the ICH group and 36 patients in the control group. Clinical data were analyzed and compared between groups to search for risk factors for ICH. The overall incidence of ICH was 28% (14/50). The in-hospital mortality rate of the ICH group was 57.1% (8/14) vs. 58.3% (21/36) in the control group. The proportion of neonates in the ICH group was 64.3% (9/14) vs. 25% in the control group (9/36) (p = 0.009), and the ICH incidence in extracorporeal cardiopulmonary resuscitation (ECPR) patients was 64.3% (9/14) vs. 13.9% (5/36) (p = 0.000). The percentage of selective cerebral perfusion in the ICH group was 64.3% (9/14) vs. 16.7% (6/36) (p = 0.001) in the control group, and the maximum procalcitonin (PCT) was 43.70 ± 30.48 ng/ml in the ICH group versus 26.92 ± 23.28 ng/ml (p = 0.050) in the control group. Multivariate analysis showed that neonates (odds ratio [OR] = 6.47 [1.09–38.46]), ECPR use (OR = 7.48 [1.26–44.41]), and maximum PCT values (OR = 1.04 [1.001–1.070]) were independent risk factors for ICH. The probability of ICH remains high in children supported with VA-ECMO after cardiac surgery. Neonatal patients, ECPR use, and PCT peak values are independent risk factors for ICH.

目的 总结小儿先天性心脏病手术后存在残余解剖畸形的患者接受体外膜肺氧合(ex-tracorporeal membrane oxygenation,ECMO)支持的临床结局.方法 回顾性分析上海儿童医学中心2017年1月1日至2020年6月30日接受ECMO支持的先天性心脏病手术后患者的临床资料及预后情况,分析残余解剖畸形和后续处理方式对其转归的影响.根据是否存在残余解剖畸形分为残余组(n=26)和非残余组(n=106),再将26例残余解剖畸形患者是否再次进行手术干预分为干预组(n=6)和非干预组(n=20).结果 在132例接受ECMO支持的术后患者中,26例(19.69％)发现存在残余解剖畸形,其中简单先心病(2例),复杂先心病(24例);主要解剖畸形为瓣膜问题(13例),残余梗阻(12例)和残余分流(5例),部分患者有多种畸形.残余组ECMO支持时间(5.26±2.17)d,明显长于非残余组的(3.96±2.77)d,差异有统计学意义(t=2.241,P=0.027);残余组病死率为80.77％,高于非残余组的45.28％,差异有统计学意义(χ2=10.539,P=0.001).26例有残余解剖畸形患者中6例进行了手术干预,干预组的存活率为50％,高于非干预组的10％(χ2=4.754,P=0.029).本组病例的死亡原因主要是低心排出量综合征、呼吸系统并发症、多器官功能衰竭和心律失常,存活者均为双心室修补的患者.结论 小儿先天性心脏病术后需要ECMO支持的患者应积极评估是否存在残余解剖畸形,尽早发现残余解剖畸形并行手术干预以改善临床预后.

目的 通过单中心研究回顾先天性心脏病患儿术后在ICU内接受体外膜氧合(ECMO)辅助的相关资料,探讨心肺复苏(CPR)对ECMO使用及预后的影响.方法 回顾性分析了上海儿童医学中心2017年1月至2019年12月期间58例患儿在先天性心脏病纠治术后于ICU接受ECMO治疗的病例资料.根据患儿是否接受CPR,将患儿分为体外心肺复苏(ECPR)组(n=26)与非心肺复苏(NCPR)组(n=32).分析两组患儿的预后及并发症等区别.结果 在ICU内安装ECMO的58例患儿中,成功撤离ECMO为40例(68.97％),出院为31例(53.45％).行ECPR的26例(44.83％)患儿中,成功撤离ECMO的患儿有14例(53.85％),出院10例(38.46％);NCPR组32例(55.17％)患儿中,撤离ECMO的患儿为26例(81.25％),出院患儿21例(65.63％),两组间的脱机率(P=0.025)与存活率(P=0.039)具有显著差异.ECPR组安装前乳酸值、ECMO中肾衰及消化道出血发生率都显著高于NCPR组(P值分别为0.001,0.030,0.039).结论 先天性心脏病患儿术后行ECPR的患儿脱机率与存活率都低于NCPR患儿,且肾功能衰竭及胃肠道出血等并发症发生率高.

目的 总结先天性心脏病术后给予体外膜氧合(ECMO)辅助并存活的新生儿早期神经发育的随访结果.方法 回顾性分析2017～2019年本院先天性心脏病术后ECMO支持的新生儿早期随访资料,包括神经系统功能、心脏基础疾病和生长发育情况.结果 随访ECMO支持后1～3年的11例患儿,男7例、女4例,ECMO启用时年龄0～27 d,体重2.3～4.1 kg.7例(63.64％)患儿的头颅MRI结果有异常,包括陈旧性脑出血2例、脑室增大和脑沟加深4例、白质减少1例.和正常组相比,异常组年龄小、体重低、ECMO前乳酸浓度高、ECPR发生率和深低温停循环的比例高(P<0.05).格里菲斯评估发现11例患儿的55项领域中有21项(38.18％)的发育商结果在临界状态以下.结论 早期随访结果提示年龄偏低、体重低于3.5 kg、ECMO前乳酸浓度高、体外心脏复苏、深低温停循环的新生儿ECMO术后神经系统受损的发生率较高,严重影响患儿的预后.但心脏ECMO后的神经发育问题有待更深入的远期随访研究.

Background Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in the treatment of heart failure after cardiac surgery in neonates. Materials and Methods Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. Results Twenty-three neonates, aged from 0 to 25 days and weight between 2,300 and 4,500g, with heart failure postcardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that nonsurvivors were related to the factors such as higher lactate value of ECMO 12 and 24hours ( p =0.008 and 0.001, respectively), longer time to lactate normalization ( p =0.001), lactate>10mmol/L before ECMO ( p =0.01), lower weight ( p =0.01), longer ECMO duration ( p =0.005), lower platelet count ( p =0.001), more surgical site bleeding ( p =0.001), and surgical residual malformation ( p =0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24hours ( p =0.003), longer ECMO duration ( p =0.015), and surgical site bleeding ( p =0.025) were independent risk factors. Conclusion ECMO was an effective technology to support the neonates with cardiopulmonary failure after open heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients' recovery.

Background: Extracorporeal membrane oxygenation (ECMO) provides circulatory support in children with congenital heart disease, particularly in the setting of cardiopulmonary failure and inability to wean from cardiopulmonary bypass. This study summarized the clinical application of ECMO in treatment of heart failure after cardiac surgery in neonates. Methods: Clinical data of 23 neonates who received ECMO support in our center from January 2017 to June 2019 were retrospectively analyzed. Results: Twenty-three neonates, aged from 0 to 25 days and weight between 2300 to 4500 g, with heart failure post-cardiotomy were supported with ECMO. The successful weaning rate was 78.26% and discharge rate was 52.17%. Bleeding and residual malformation were the most common complications. The univariate analysis showed that non-survivors were related to the factors such as higher lactate value of ECMO 12h, 24h (P=0.008, 0.001, respectively), longer time to lactate normalization (P=0.001), lactate>10 mmol/L before ECMO (P=0.01), lower weight (P=0.01), longer ECMO duration (P=0.005), lower platelet count (P=0.001), more surgical site bleeding (P=0.001) and surgical residual malformation (P=0.04). Further logistic regression analysis revealed that higher lactate value of ECMO 24h (P=0.003), longer ECMO duration (P=0.015) and surgical site bleeding (P=0.025) were independent risk factors. Conclusions: ECMO was an effective technology to support the neonates with cardiopulmonary failure after open-heart surgery. Control the lactate acidosis and surgical site bleeding event may be helpful for patients’ recovery.

Background: The aim of our study was to analyze the risk factors of nosocomial infection after cardiac surgery in children with congenital heart disease (CHD). Methods: We performed a retrospective cohort study, and children with CHD who underwent open-heart surgeries at Shanghai Children’s Medical Center from January 1, 2012 to December 31, 2018 were included. The baseline characteristics of these patients of different ages, including neonates (0-1 months old), infants (1-12 months old) and children (1-10 years old), were analyzed, and the association of risk factors with postoperative nosocomial infection were assessed. Results: A total of 11651 subjects were included in the study. The overall nosocomial infection rate was 10.8%. Nosocomial infection rates in neonates, infants, and children with congenital heart disease were 32.9%, 15.4%, and 5.2%, respectively. Multivariate logistic regression analysis found age (OR 0798, 95%CI: 0.769-0.829; P<0.001), STS risk grade (OR 1.267, 95%CI: 1.159-1.385; P<0.001), body mass index (BMI) <5th percentile (OR 1.295, 95%CI: 1.023-1.639; P=0.032), BMI ＞95th percentile (OR 0.792, 95%CI: 0.647-0.969; P=0.023), cardiopulmonary bypass (CPB) time (OR 1.008, 95%CI: 1.003-1.012; P<0.001) and aortic clamping time （OR 1.009, 1.002-1.015; P = 0.008）were significantly associated with nosocomial infection in CHD infants. After adjusted for confounding factors, we found STS risk grade (OR 1.38, 95%CI: 1.167-1.633; P<0.001), BMI<5th percentile (OR 1.934, 95%CI: 1.377-2.715; P<0.001), CPB time (OR 1.018, 95%CI: 1.015-1.022; P<0.001), lymphocyte/WBC ratio﹤cut off value (OR 3.818, 95%CI: 1.529-9.533; P=0.004) and AST＞cut off value (OR 1.546, 95%CI: 1.119-2.136; P=0.008) were significantly associated with nosocomial infection in CHD children. Conclusion: Our study suggested STS risk grade, BMI, CPB duration, low lymphocyte/WBC or high neutrophil/WBC ratio were independently associated with nosocomial infection in CHD infant and children after cardiac surgery.

目的 总结单纯室间隔缺损患者围手术期情况,评估室间隔缺损的最适手术时机.方法 收集2014年7月至2017年12月所有简单室间隔缺损患儿手术情况,短期预后和医疗费用,分析其最佳手术年龄.结果 本研究最终纳入2263例患儿,分为<3月,≥3～<6月,≥6～<12月,≥1～<3岁和≥3岁以上5个年龄阶段.分析显示,6个月以下患儿体外循环转流时间和主动脉阻断时间都明显高于6个月以上患儿,1岁以下患儿术后ICU时间和住院时间都明显高于1岁以上患儿,6个月以下患儿的住院费用显著高于6个月以上患儿.在并发症中3个月以下患儿感染发生率最高.其余并发症如脑出血、肺高压危象等各组间虽有统计学差异,但发生率低,临床意义不明显.结论 根据本组室间隔缺损患儿的围手术期资料,建议单纯室间隔缺损患儿手术时间以1岁左右为宜.

目的 探讨儿童患者体外膜氧合(ECMO)合并胃肠道(GI)出血发病的危险因素,为早期干预提供理论依据.方法 回顾性分析2017年至2018年上海儿童医学中心心脏术后围ECMO期间GI出血患儿(出血组)和无GI出血患儿(对照组)的临床资料,对基本信息、临床表现、喂养状况、并发症、结局等方面进行总结,对出血组的危险因素进行分析.结果 共70例先天性心脏病患儿术后接受ECMO辅助治疗,男38例,女32例,年龄为0 d～12岁,体重为2.30～26 kg,ECMO支持的时间为11～456 h,其中成功撤机41例(58.57％),存活出院30例(42.86％).发生GI出血(出血组)8例(11.43％),成功撤机4例(50％),存活出院2例(25％).与62例无GI出血(未出血组)相比,两组在体外心肺复苏术(ECPR)、合并脑出血、血小板计数(PLT)最低值和平均值、每天的红细胞输注量等的差异均有统计学意义(P<0.05).单因素分析ECPR、C反应蛋白升高、颅内出血、每天输血量和PLT较低五个因素与GI出血有关.Logistic回归分析ECPR和PLT较低为GI出血的独立危险因素(P<0.05).结论 GI出血患儿的死亡率高达75％.ECPR和PLT计数较低为GI出血的主要危险因素,应高度重视这些因素,早期干预以改善预后.

Extracorporeal membrane oxygenation (ECMO) provides cardiorespiratory support during cardiopulmonary resuscitation unresponsive to conventional methods. Here, we analyzed the extracorporeal cardiopulmonary resuscitation (ECPR) results of children in a cardiac arrest setting after cardiac surgery. Of 3119 cases of pediatric open-heart surgery, 31 required postoperative ECMO. Among the 31 patients, 11 experienced cardiac arrest and ECPR in the early postoperative period. These 11 patients' median age is 1.5 [range, 0.1-19] months and median weight is 3.9 [range, 2.9-10.3] kg. The medical records of ECPR cases were analyzed. The median ECMO-assisted time was 68 (range, 13-456) hours and 4 cases (36.4%) survived. The ECMO-assisted times were ≤2 days in 4 patients (all eventually died), ≥6 days in 3 patients (all also died), and all 4 cases supported for 2-6 days were discharged successfully (P = 0.006). In the survivors and nonsurvivors, peak lactate levels were 10.8 ± 7.04 and 22.8 ± 6.98 mmol/L (P = 0.023) and peak creatinine levels were 47.50 ± 25.9 and 153.7 ± 73.9 mg/dL (P = 0.035), respectively. In these 11 ECPR cases, the most common complications were bleeding requiring re-exploration (n = 6, 54.5%) and renal failure (n = 6, 54.5%). The incidence of renal failure was significantly correlated with hypoperfusion time (P = 0.015). ECPR is valuable in children with postoperative cardiac arrest. The higher peak lactate level, higher peak creatinine level, and prolonged ECMO duration were associated with higher mortality. Early diagnosis and intervention of residual anatomical problems could improve survival. Bleeding and renal failure were the most common complications and the incidence of renal failure may be correlated with longer hypoperfusion duration.

目的 通过使用“Orpheus”灌注模拟设备进行体外循环模拟训练,旨在提高灌注师的基本灌注技能以及应对术中严重意外事件的能力,提升团队合作的意识.方法 8名具备体外循环临床经验但年资较低(＜2年)的灌注师参与本模拟训练,两人一组,使用“Orpheus”灌注模拟设备设计4种不同的体外循环意外场景.指导老师带领每组学员分析讨论意外场景所产生的各种原因及处理方法,并提出预防措施.对学员的临床评估预判、专业知识、操作技术及交流互动各方面的表现进行综合评分.结果 学员们在初次模拟时表现为认识评估不确切,团队协作交流不充分,对手术产生一定影响,评分较低,经过指导老师的教学与指导后再次模拟,各方面表现均有所改善,评分得到了非常显著地提高(P＜0.01).结论 通过体外循环模拟培训可以有助于提升灌注师的批判性思维技能以及以标准化方式应对严重意外事件的能力.