先天性膈疝患儿围手术期处理

Perioperative Period Management of Congenital Diaphragmatic Hernia in Children

目的探讨先天性膈疝(CDH)围手术期处理,以期提高CDH患儿生存率。方法回顾性分析2004年5月-2008年12月本院收治的确诊CDH的17例病例。比较其中新生儿与非新生儿患儿电解质平衡、酸碱平衡紊乱的发生率,取二组手术病例对比手术后呼吸支持需要率以及呼吸支持时间。应用SPSS10.0软件进行统计学分析。结果新生儿组酸碱平衡紊乱的发生率明显高于非新生儿组(100.0%vs37.5%,χ2=6.561,P<0.05)。术后,新生儿组呼吸支持需要率明显高于非新生儿组(100.0%vs28.6%,χ2=5.238,P<0.05),新生儿组呼吸支持时间(222.75h)较非新生儿组(8.50h)明显延长。结论新生儿与非新生儿相比,手术前酸碱平衡紊乱较明显,术后可能更加需要呼吸支持。细致的围手术期处理有助于提高治疗效果。

Objective To summarize the clinical perioperative management of congenital diaphragmatic hernia（CDH） in order to improve the survival rate in children.Methods The clinical data from 17 cases with CDH in the period of May.2004-Dec.2008 were reviewed.The incidences of acid-base and electrolyte imbalance were compared between the neonates （neonate group）and no-neonate group.The patients receiving operation were divided into neonate group and no-neonate group,and the rates of requiring respiratory support and time course were compared between the two groups.SPSS 10.0 software was used to analyze the data.Results The incidence of acid-base imbalance in neonate group was higher than that in no-neonate group（100.0% vs 37.5%,χ2=6.561,P0.05）.The proportion of postoperative respiratory support in neonate group was higher than that in no-neonate group（100.0% vs 28.6%,χ2=5.238,P0.05）,and the support course in neonate group was also longer than that in no-neonate group（222.75 h vs 8.50 h）.Conclusions Compared with the infants,the incidence of preoperative acid-base imbalance was much more higher and was prone to require postoperative respiratory support in neonates.Meticulous perioperative management for CDH patients could improve the survival.