新生儿重症先天性膈疝的治疗进展

Advances in the management of neonates with high-risk congenital diaphragmatic hernia

新生儿出生后 6小时内出现呼吸窘迫综合征 ( RDS)的重症先天性膈疝 ,治疗比较困难 ,死亡率较高。过去对重症先天性膈疝患者须行紧急手术的观点已受到强烈质疑 ,近年来主张先通过各种治疗措施使患者呼吸循环稳定后再施行修补手术的治疗方案 ,其疗效较以前有所提高。现就一般措施、机械通气、体外膜肺、吸入性一氧化氮、激素类药物、肺泡表面活性物质、外科手术时机及其术式等方面对其治疗进行综述。

The management of neonates with high risk congenital diaphragmatic hernia (CDH) which gives rise to respiratory distress syndrome in 6 hours after born is so troublesome that the mortality is very high. The past advocation that CDH should accept emergency operation has been called in question. Another therapeutic procedure is recommended that CDH repair operation should be performed after the respiration and circulation has been stabilized. This procedure has presented better effect than before. The present advances in the management including general measures, mechanical ventilation, extracorporal membranous oxygenator (ECMO), nitric oxide (NO) inhalation, glucocorticoid, pulmonary surfactant, CDH repair and so on were reviewed.