新生儿先天性膈疝的围手术期处理  

Perioperative management of congenital diaphragmatic hernia in neonates

作　　者：陈中献[1] 刘文英[1] 熊忠讯[1] 徐畅[1] 蒋小平[1] 胡廷泽[1] 

机构地区：[1]四川大学华西医院小儿外科,成都610041

出　　处：《中华小儿外科杂志》2005年第9期457-460,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的总结先天性膈疝的围手术期处理经验,以提高先天性膈疝患儿的抢救成功率和生存质量。方法回顾性对比研究四川大学华西医院1998年1月至2005年4月23例新生儿先天性膈疝患儿的围手术期处理的资料,接受手术21例,其中重症患儿16例,延期手术11例,紧急手术5例;非重症患儿5例,延期手术4例,紧急手术1例。结果急诊手术6例中,存活3例,延期手术15例中,存活11例。重症组中延期手术组,病死率为36.4%,紧急手术组病死率为60%,而非重症组中紧急手术和延期手术病例均存活。产前经B超检出的12例,无论是紧急手术还是延期手术,均全部存活。术后并发切口感染2例、切口裂开1例、肺部感染3例、硬肿症2例,死亡(呼吸循环衰竭)7例。死亡病例均为重症,其中并发肺部感染者2例,并发硬肿症者1例,均为紧急手术者。结论对重症先天性膈疝患儿,积极改善肺功能,待呼吸循环状况稳定后延期手术治疗,可以提高患儿的存活率。Objective To summarize the experience of the perioperative management of congenital diaphragmatic hernia （CDH） in neonates. Methods The clinical data from 23 cases with CDH were reviewed. These patients were divided into two groups： group 1 （n= 16） in which patients showed the symptoms within the first 6 hours of life, and group 2 （n= 7） in which patients showed the symptoms after 6 hours of life. Six patients underwent emergency operation, and the others were delayed to surgical treatment until their status of respiration and circulation were improved to stabilize. Results There was no death in group 2. In group 1, 3 （60%） patients died after emergency operation and 4 （36. 4%） neonates died after delayed operation. After operation, wound infection happened in 2 cases, wound dehiscence in 1, pulmonary infection in 2, and sclerema in 2. Conclusions Appropriate perioperative management can enhance survival rate of CDH in neonates.

关 键 词：膈疝 先天性 围手术期 重症先天性膈疝 围手术期处理 新生儿 四川大学华西医院 呼吸循环衰竭 重症患儿 紧急手术 延期手术 

分 类 号：R726.1[医药卫生—儿科]