未经产前诊断的新生儿先天性膈疝的临床诊断与治疗

Q4 Medicine

中华小儿外科杂志 Pub Date : 2020-01-15 DOI:10.3760/CMA.J.ISSN.0253-3006.2020.01.004

D. Pan, Wenya Xie, Zhongyuan Sun, X. Mu, Huifeng Liu, Min Yang, Xiaoyong Li, L. Shao

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引用次数: 0

摘要

目的总结产前未确诊新生儿先天性膈疝(CDH)的临床特点、治疗及预后，探讨非三级中心新生儿先天性膈疝的临床诊治经验。方法2010年1月至2018年12月，我院急诊收治136例CDH新生儿。排除5例因特殊原因未治疗的病例。没有产前诊断。男77例，女54例，胎龄(38.3±1.5)(32.0 ~ 41.0)周，出生体重(3102.8±473.6)(2000.0 ~ 420.0)g。受累侧分别为左侧(n=115)和右侧(n=16)。并发症包括肺动脉高压(21例)及相关畸形(81例)。术前状态为机械通气(n=92)，自主呼吸(n=39)。根据入院年龄分为出生前48小时入院组和出生后48小时入院组。结果具体手术包括胸腔镜手术(58例)和剖腹手术(14例)。死亡发生在术前(n=2)和术后(n=12)。积极治疗2例术前死亡，手术129例。术后死亡或放弃治疗12例，存活117例(89.3%)。入院≤48 h组死亡率(14/90,15.6%)高于入院≤48 h组(0)(P<0.05)。早产儿、肺动脉高压、严重心脏畸形死亡率较高(P<0.05)。入院时pH值、PaO2值及术后平均pH值均明显低于存活患者。死亡患者入院时PaCO2明显高于存活患者(P<0.05)。结论产前未确诊的新生儿CDH，特别是严重病例，可能对产后治疗提出挑战。发病越早，病情越严重，死亡率越高。合并肺动脉高压、早产和严重心脏畸形的CDH死亡率较高。关键词:婴幼儿;新生儿;膈疝;产前诊断;治疗;预后

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Clinical diagnoses and treatments of congenital diaphragmatic hernia of neonates without a prenatal diagnosis

Objective To summarize the clinical characteristics, treatments and prognoses of congenital diaphagmatic hernia (CDH) in prenatal undiagnosed neonates and to explore the clinical diagnostic and therapeutic experiences of neonatal CDH at a non-tertiary center. Methods From January 2010 to December 2018, a total of 136 CDH neonates were admitted by emergency clinic. Five untreated cases due to special reasons were excluded. No prenatal diagnosis was made. There were 77 boys and 54 girls with a gestational age of (38.3±1.5)(32.0-41.0) weeks and a birth weight of (3102.8±473.6)(2000.0-4120.0) grams. The involved side was left (n=115) and right (n=16). The complications included pulmonary hypertension (n=21) and associated malformations (n=81). The preoperative status was mechanical ventilation (n=92) and spontaneous breathing (n=39). According to admission age, they were divided into two group of admission before and after 48 hours after birth. Results The specific procedures included thoracoscopy (n=58) and laparotomy (n=14). Death occurred preoperatively (n=2) and postoperatively (n=12). Two actively treated cases eventually died preoperatively and 129 cases were operated. Twelve cases died or abandoned treatment at post-operation and 117 cases (89.3%) survived. The mortality rate of ≤48 h admission group (14/90, 15.6%) was higher than that of >48 h admission group (0)(P<0.05). The mortality rate of premature infants, pulmonary hypertension and severe cardiac malformation were relatively high (P<0.05). And the values of pH and PaO2 at admission, mean postoperative pH in deceased cases were significantly lower than those in survivors. And PaCO2 at admission was significantly higher in deceased cases than that in survivors (P<0.05). Conclusions Prenatally undiagnosed neonatal CDH, especially in severe cases, may present challenges for postpartum treatment. With earlier onset and more severe condition, the higher mortality rate will be. Mortality is higher in CDH with pulmonary hypertension, preterm birth and severe cardiac malformation. Key words: Infant, newborn; Diaphragmatic hernia; Prenatal diagnosis; Therapy; Prognosis

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来源期刊

中华小儿外科杂志 Medicine-Pediatrics, Perinatology and Child Health

CiteScore

0.40

自引率

0.00%

发文量

8707

期刊介绍： Chinese Journal of Pediatric Surgery is an academic journal sponsored by the Chinese Medical Association. It mainly publishes original research papers, reviews and comments in this field. The journal was founded in 1980 and is included in well-known databases such as Peking University Journal (Chinese Journal of Humanities and Social Sciences) and CSCD Chinese Science Citation Database Source Journal (including extended version). It is one of the national key academic journals under the supervision of the China Association for Science and Technology. Chinese Journal of Pediatric Surgery enjoys a high reputation and influence in the academic community. The articles published in this journal have a high academic level and practical value, providing readers with a large number of practical cases and industry information, and have received widespread attention and citations from readers.