临床儿科杂志 ›› 2017, Vol. 35 ›› Issue (9): 645-.doi: 10.3969/j.issn.1000-3606.2017.09.002

• 围产新生儿疾病专栏 • 上一篇    下一篇

优化围手术期临床管理策略对先天性膈疝诊治疗效的影响

朱莹 1, 王俊 2, 杨祖菁 3, 朱建幸 1, 谢利娟 1   

  1. 上海交通大学医学院附属新华医院 1.新生儿科,2.儿外科,3.产科(上海    200092)
  • 收稿日期:2017-09-15 出版日期:2017-09-15 发布日期:2017-09-15
  • 通讯作者: 谢利娟 E-mail:xielijuan@xinhuamed.com.cn

The effects of optimizing perioperative management strategy on the diagnosis and treatment of congenital diaphragmatic hernia

ZHU Ying1, WANG Jun2, YANG Zujing3, ZHU Jianxing1, XIE Lijuan1   

  1. 1. Department of Neonatology, 2. Department of Pediatric Surgery, 3. Department of Obstetrics, Xinhua Hospital Affiliated to Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
  • Received:2017-09-15 Online:2017-09-15 Published:2017-09-15

摘要: 目的 探讨膈疝产前诊断后规范化处理及技术流程的优化改进对先天性膈疝(CDH)诊治的影响。方法 回 顾分析2005年1月到2016年8月入住新生儿重症监护室、诊断为CDH的新生儿病例临床资料。依据规范化处理实施时间, 将2010年1月至2016年8月收治的93例CDH作为干预组,2005年1月至2009年12月收治的15例CDH作为对照组,比较 两组生存率、并发症等临床结局。结果 两组患儿在性别、出生胎龄、出生体质量、Apgar评分和CDH位置方面的差异均 无统计学意义(P>0.05);干预组的总存活率为81.7%,对照组为53.3%,差异有统计学意义(P<0.05);两组的机械通气 模式和气胸发生率的差异也均有统计学意义(P<0.05);对照组的中位手术时间为4.5 h,干预组为49.5 h,术后存活率对 照组为61.5%,干预组为90.5%,两组差异均有统计学意义(P<0.05);两组死亡病例的首次血气分析显示,pH值和PCO2 值的差异均有统计学意义(P<0.05)。 结论 优化膈疝围手术期的临床处理对提高CDH的存活率以及减少并发症有积极 的促进作用,干预组死亡病例存在更严重的肺发育不良。

Abstract:  Objectives To explore the influence of standardized treatment and technical flow improvement on the diagnosis and treatment of congenital diaphragmatic hernia (CDH) after prenatal diagnosis. Methods The clinical data of neonates diagnosed with CDH who were hospitalized in neonatal intensive care unit from January 2005 to August 2016 was analyzed retrospectively. Based on the start time of standardized treatment implementation, 93 cases of CDH hospitalized from January 2010 to August 2016 were divided into the intervention group while 15 cases of CDH hospitalized from January 2005 to December 2009 were divided into the control group. The survival rate and complications of clinical outcomes between two groups were compared. Results There was no significant difference in sex, gestational age, birth weight, Apgar score, and CDH position between two groups (P >0.05). The total survival rate was 81.7% in the intervention group and 53.3% in the control group, and there was statistical difference (P<0.05). The difference of mechanical ventilation mode and pneumothorax rate between two groups also had statistical difference (P >0.05). The median operation time in the control group was 4.5 h and the intervention group was 49.5 h. The postoperative survival rate was 61.5% in the control group and 90.5% in the intervention group, and the differences between two groups were significant (P >0.05). The first blood gas analysis of deaths cases in both groups showed that there were significant differences in pH and PCO2 values (P >0.05). Conclusions Optimization of the clinical management during perioperative period can improve the survival rate of CDH and reduce complications. However, the dead cases in the intervention group had more severe pulmonary hypoplasia.