摘要
先天性膈疝(CDH)是仅次于肺发育不良和呼吸衰竭的高死亡风险因素之一。在实验动物中,幼胎气管闭塞(TO)法可促进动物肺的生长及形态学成熟。作者对采用胎儿TO方法治疗重症CDH进行了随机实验,对纳入本研究的20例儿童的肺功能指标进行检测,[9例采用传统方法(对照组),11例采用TO方法]。假设TO 能够改善肺功能。在出生时,TO组的婴儿的平均胎龄较小(30.8±2.0周vs 37.4±1.0周,P=0.000 2)。所有婴儿需要辅助通气。两组间死亡率无差异TO组与对照组分别为64% vs 78%,P=0.64)。在以下4个时段对呼吸功能进行测定:①生后最初24 h;
Congenital diaphragmatic hernia (CDH) carries a high-mortality risk secondary to pulmonary hypoplasia and respiratory failure. In experimental animals, fetal tracheal occlusion (TO) induces lung growth and morphologic maturation. We measured indicators of pulmonary function in 20 infants who were enrolled in a randomized trial of fetal TO as treatment for severe CDH [nine with conventional treatment (controls); 11 with TO]. We hypothesized that TO would improve lung function. At birth, the TO group had a lower mean gestational age (30. 8 ± 2. 0 versus 37. 4 ± 1. 0 wk; p =0. 0002) . All infants required assisted ventilation. Mortality did not differ between groups (64 versus 78% , TO and control, respectively; p = 0. 64) . We measured respiratory mechanics at four study points: 1) first 24 h, 2) before CDH operative repair (5. 9 ± 2. 2 d), 3) immediately after repair (7. 0 ± 2. 2d), and 4) before elective extubation (32. 5 ± 16. 1 d). We calculated perioperative oxygenation index and alveolar-arterial oxygen difference to assess efficiency of pulmonary gas exchange. Data were analyzed by univariate and repeated measures techniques. Respiratory system compliance (Crs) was low. The rate of increase in Crs over the four study points was greater in the TO group than in control subjects. Crs in the TO group was significantly greater at study 2 (0. 28 ± 0. 12 versus 0. 17 ±0.04 mL ·cmH2O-1·kg-1; p = 0.02) and study 4 (0.93±0.45 versus 0.51 ± 0. 16 mL · cmH2O-1 · kg-1; p = 0. 02) . oxygenation index did not differ between groups, but alveolar-arterial oxygen difference was lower in the TO infants. We conclude that fetal TO for severe CDH results in modest improvements in neonatal pulmonary function that are of questionable clinical significance.
