先天性膈疝术后肺功能转归的临床研究

Pulmonary function in infants with congenital diaphragmatic hernia

目的探索先天性膈疝患儿术后肺功能的转归情况。方法收集2016年11月至2019年3月在上海交通大学医学院附属新华医院小儿外科门诊随访并行肺功能检查的膈疝患儿肺功能数据,同时收集患儿治疗时的临床资料,包括患儿性别、膈疝类型、Apgar评分、出生体重、肝脏位置、血气分析、呼吸机维持时间和住院周期等进行统计分析。结果45例患儿纳入分析,其中男19例,女26例;左侧膈疝39例,右侧6例。共行89次肺功能检查,随访时间为(9.3±7.3)个月,20例患儿行1次检查,25例行2次及以上检查。以最近一次肺功能检查数据为准,45例患儿中呼吸功能正常者有7例(15.6%),呼吸功能存在异常组有38例(84.4%)。肺功能检查表现为潮气呼吸功能正常、阻塞性通气功能障碍、混合性通气功能障碍、限制性通气功能障碍的分别为10次、62次、11次和6次。肺功能检查时间、膈疝类型和肝脏疝入情况与肺功能检查结果存在相关性(P<0.05)。与限制性通气功能障碍组患儿的月龄相比,阻塞性通气功能障碍组患儿的月龄较大[(8.9±6.9)个月比(1.3±0.5)个月,P=0.001]。25例接受多次肺功能检查结果显示,随着患儿年龄的增长,其"达峰时间比"和"达容时间比"显著增加(P<0.05)。结论部分先天性膈疝患儿术后早期存在不同程度的肺功能异常,需给予高度重视;年龄、膈疝类型和肝脏疝入情况可能是影响肺功能异常的危险因素。

Objective To assess the pulmonary function recovery of infants with congenital diaphragmatic hernia(CDH).Methods The medical records were retrospectively reviewed for CDH infants receiving pulmonary function test(PFT)from November 2016 to March 2019.The relevant data included lung function,follow-up time,gender,sideness of hernia,Apgar score,birth weight,location of liver,admission arterial blood gas analysis,duration of mechanical ventilation and length of hospital stay.Results Forty-five infants were included for analysis.There were 19 boys and 26 girls.And the involved side was left(n=39)and right(n=6).PFT was performed for a total of 89 cases.The mean age at PFT was(9.3±7.3)months.And the frequency of PFT was once(n=20)and twice and more(n=25).Pulmonary function was normal(n=7,15.6%)and abnormal(n=38,84.4%).The results were normal pulmonary function(n=10),airflow obstruction(n=62),mixed ventilatory dysfunction(n=11)and airflow restriction(n=6).Significant correlation existed between lung function and age at PFT,sideness of hernia and liver herniation(all P<0.05).Compared with counterparts with airflow restriction,those with airflow obstruction had a later age of PFT[(8.9±6.9)vs.(1.3±05)months,P=0.001].As compared with previous indices,percent of expiratory time to peak tidal time and percent of tidal volume to peak tidal expiratory flow increased subsequently.Conclusions Pulmonary function abnormality is present in some CDH survivors after repairing.Lung function may be correlated with age at PFT,sideness of hernia and liver herniation.