先天性重症膈疝围手术期多学科综合诊疗经验

Experience in perioperative multi-disciplinary diagnosis and treatment of congenital severe diaphragmatic hernia

目的总结采用围手术期多学科综合诊疗应用于先天性重症膈疝的治疗经验并探讨其对诊治的影响。方法回顾分析我院2011年2月至2019年08月我院105例出生10d内出现呼吸衰竭的新生儿重症膈疝的临床资料。将采用传统非MDT治疗的25例患者为对照组,对照组中男17例,女8例,采用MDT模式治疗的80例患者作为实验组,对比两组患者术前死亡、术前达到临床稳态、达到稳态放弃例数、手术例数、术前呼吸机使用时间、手术方式、术中使用补片例数、术后呼吸机维持时间、手术后存活情况。结果非MDT组25例患儿中7例患儿出现呼吸循环衰竭(28%),18例患儿术前达到临床稳态。MDT组80例患儿11例患儿术前出现呼吸循环衰竭(13.8%),69例患儿术前达到临床稳态。于非MDT组患儿比较,MDT组术前达到稳态放弃病例数比例更少(P=0.017)。非MDT组在入院后29.33±15.39h行急诊手术治疗,MDT组病例在65.91±32.64h达到临床稳态后手术治疗,两组患儿术前呼吸机使用时间存在明显差异(P=0.002)。比较两组患者手术方式、术中使用补片及术后呼吸机维持时间方面差异无统计学意义(P>0.05)。非MDT组术后存活率为66.7%(6/9),MDT组术后存活率为81.5%(44/54)。结论通过开展围手术期多学科综合诊疗模式有助于建立家属治疗的信心,让更多的重症膈疝患儿得到合理及时的治疗。

Objective To summarize the experience of perioperative multidisciplinary comprehensive diagnosis and treatment in the treatment of congenital severe diaphragmatic hernia.To investigate the effect of this method on diagnosis and treatment.Methods Clinical data of 105 neonates with severe diaphragmatic hernia with respiratory failure within the first 10 days of life were analyzed from February 2011 to August 2019.A total of 25 patients receiving traditional non-MDT treatment were selected as the control group,including 17 males and 8 females,and 80 patients receiving MDT mode treatment as the experimental group.The number of preoperative death,preoperative clinical homeostasis,steady-state abandonment,surgical cases,preoperative time of ventilator use,surgical method,intraoperative number of patch use,postoperative ventilator maintenance time,and postoperative survival were compared between the two groups.Results In the non-MDT group,7 of 25 children developed respiratory and circulatory failure(28%),and 18 children achieved clinical homeostasis before surgery.In MDT group,11(13.8%)of 80 children developed respiratory and circulatory failure before surgery,and 69 children achieved clinical homeostasis before surgery.Compared with the non-MDT group,the proportion of patients who achieved stable state abandonment before surgery was lower in the MDT group(P=0.017).Patients in the non-MDT group received emergency surgical treatment at(29.33±15.39)h after admission,and patients in the MDT group received surgical treatment at(65.91±32.64)h after reaching clinical homeostatic state.There were significant differences in the duration of use of ventilator before surgery between the two groups(P=0.002).There was no significant difference between the two groups in surgical methods,intraoperative mesh use and postoperative ventilator maintenance time(P>0.05).Postoperative survival rate was 66.7%(6/9)in the non-MDT group and 81.5%(44/54)in the MDT group.Conclusion By carrying out the perioperative multidisciplinary comprehensive diagnosis and treatment mode for severe diaphragmatic hernia,it is helpful to build family members'confidence in treatment,so that more children with severe diaphragmatic hernia can receive reasonable and timely treatment.