新生儿先天性膈疝诊治及预后相关因素分析——单中心近10年经验总结

Diagnosis,treatment and prognosis of neonatal congenital diaphragmatic hernia: a single center 10-year experience

目的总结本院近10年来收治的新生儿先天性膈疝(congenital diaphragmatic hernia,CDH)病例临床特点、治疗变化及预后情况,探讨新生儿膈疝的诊治与预后相关因素。方法本院于1985年1月至2004年12月(第一阶段)收治31例,2005年01月至2015年12月收治117例。第一阶段均采取开放手术,第二阶段采取腔镜手术32例,开放手术66例。对性别、年龄、出生体重、Apgar评分、产前诊断、胎龄、合并畸形、血气分析、延期手术、围术期NO吸入、手术方法、术后并发症及预后情况进行回顾性分析。统计学处理采用方差分析、卡方检验和Logistic回归分析等方法。结果第一阶段:重症20例,轻症11例;男19例,女12例;左侧28例,右侧3例;产前诊断3例,伴发畸形6例;存活25例,死亡6例。第二阶段:重症64例,轻症53例;男75例,女42例;左侧102例,右侧15例;产前诊断21例,伴发畸形24例;存活91例,死亡26例。第一阶段重症组平均住院时间(17.2±11.5)d,呼吸机使用时间(3.28±2.30)d,ICU平均住院时间(11.7±14.5)d。第二阶段重症组平均住院时间(19.7±12.7)d,平均呼吸机使用时间(6.56±4.63)d,ICU平均住院时间(12.9±12.3)d,术后出现败血症3例,心包积液2例,胃食管返流1例。膈疝复发7例,其中腔镜手术复发4例。结论近10年来本院收治重症膈疝患儿病情更为复杂、危重;入院时较低血PH值、1分钟Apgar评分、5分钟Apgar评分与预后相关。

Objective To explore the changes of clinical characteristics,treatments and prognosis of congenital diaphragmatic hernia （CDH）.Methods There were 31 patients during the first period of January 1985 to December 2004 while another 117 patients during the second period of January 2005 to December 2015.Gender,age,birth weight,Apgar score,prenatal diagnosis,gestational age,combined deformities, blood gas analysis,delayed surgery,perioperative nitric oxide inhalation,operation methods,postoperative complications and prognosis were reviewed.And analysis of variance,chi -square and regression analysis were performed.Results During the first period,there were 20 severe and 11 mild cases （19 boys and 12 girls,28 left CDH,3 right CDH）.Three cases were diagnosed during prenatal examinations.Six cases had combined simple deformity.Twenty -five cases survived while 6 cases died.During the second period,there were 64 se-vere and 53 mild cases （75 boys,42 girls,102 left CDH,15 right CDH）.Twenty -one cases were diagnosed prenatally.Twenty -four cases had combined deformity.And 91 cases survived and 26 cases died.During the first period,length of hospital stay,ventilator support time and length of intensive care unit （ICU）stay were 17.2 ±11.5,3.28 ±2.30 and 11.7 ±14.5 days respectively.During the second period,length of hospital stay,ventilator support time and length of ICU stay were 17.2 ±11.5,28 ±2.30 and 11.7 ±14.5 days.Dur-ing the second period,there were postoperative sepsis （n =3）,pericardial effusion （n =2）and gastroesopha-geal reflux （n =1）.And among 7 recurrent cases,there were 4 thoracoscopic cases. Conclusions Over the last decade,severe CDH has become more complex and severe.And 1 /5 -min Apgar score and admission pH value are correlated with prognosis.