先天性膈疝患儿手术后近期肺功能的临床观察

Postoperative pulmonary function in children with congenital diaphragmatic hernia

目的观察不同临床分组先天性膈疝患儿术后肺功能恢复情况,以指导临床随访。方法收集2014年1月至2015年12月期间因先天性膈疝(左后外侧疝)行手术治疗患儿的临床资料,按临床症状分为轻症组和重症组,比较两组患儿术后肺功能、胸片、肺动脉压和临床表现的差异。结果以最后一次随访时间为准,轻症组仅1例患儿体重低于中位数而其身高在中位数,重症组5例中,1例患儿体重低于中位数,2例患儿身高低于中位数。轻症组术后1个月肺功能异常主要以阻塞性病变为主,手术2个月后部分患儿肺功能可恢复正常;而重症组术后1个月主要表现为混合性病变,手术2个月后主要表现为阻塞性病变。轻症组仅1例有肺不张,而重症组4例有肺不张。轻症组胸片肺渗出吸收早于重症组,肺动脉高压程度更轻,恢复更快。结论膈疝患儿在术后仍然存在各种肺功能异常,肺动脉高压和肺炎都是影响肺功能恢复的因素,胸片和心脏彩超可辅助评估术后肺功能和肺动脉压。

Objective To explore the pulmonary function recovery of children with congenital diaphragmatic hernia and guide its clinical treatment. Methods A postoperative follow-up study was conducted for patients with congenital diaphragmatic hernia from January 2014 to December 2015. They were divided into mild and severe groups. Lung function,chest radiography and pulmonary arterial pressure and clinical manifestations were recorded and analyzed. And postoperative lung functions were compared between two groups. Results Based on the most reecent result,only one child＇s weight was less than the median and one child＇s height was around the median in mild group. In severe group,one children＇s weight were less than the median and two children＇s height were less than the median. Pulmonary function abnormalities,mostly obstructive lesions,could be found in mild group early after surgery. Mixed lesions were found during an early period and obstructive lesions during a late period in severe group. One child in mild group was with atelectasis and four children in severe group were with atalectasis. Compared with mild group,pulmonary inflammation absorption was quicker,pulmonary artery pressure lower and recovery sooner. Conclusion Various abnormalities of lung function still exist postoperatively in children with diaphragmatic hernia. Pneumonia and pulmonary hypertension affect lung function recovery.Chest radiography and cardiac color ultrasound are helpful for evaluating postoperative lung function and pulmonary artery pressure.