新生儿胸腹裂孔疝肺发育不良程度与预后关系  

Relationship between the degree of pulmonary dysplasia and prognosis in neonates with pleuroperitoneal foramen hernia

作　　者：刘叶[1] 王贤书[1] 王盛华[1] 谷红霞[1] 杜娟 岳芳[1] 曹红宾[1] 方江顺[1] 李鑫[1] LIU Ye;WANG Xian-shu;WANG Sheng-hua;GU Hong-xia;DU Juan;YUE Fang;CAO Hong-bin;FANG Jiang-shun;LI Xin

机构地区：[1]河北省儿童医院胸外科,石家庄市050031

出　　处：《护理实践与研究》2020年第19期123-126,共4页Nursing Practice and Research

基　　金：河北省医学科学研究课题(20190832)。

摘　　要：目的探讨新生儿胸腹裂孔疝肺发育不良程度与预后的关系。方法选取2007年6月至2017年6月收治的62例新生儿胸腹裂孔疝患儿作为研究对象。依据患儿生后症状出现时间、血气分析、CR/CT/MRI、肺压缩体积、肺动脉压力及术中双肺扩张情况等将肺发育不良程度分为三组,轻度组19例;中度组26例;重度组17例。采用围手术期肺保护性通气策略,病情稳定后再手术等治疗。结果结果显示,三组患儿年龄两两比较显示,轻度组与中度组比较(P>0.05);轻度组与重度组比较(P<0.05);中度组与重度组比较(P<0.05)。性别、发病侧别、有无疝囊的两两比较显示均无统计学意义(P>0.05)。合并症:三组肺发育不良术前肺动脉高压两两比较,轻度组与中度组比较(P<0.05);轻度组与重度组比较(P<0.05);中度组与重度组比较(P>0.05)。肺炎、心肌损害两两比较显示,轻度组与中度组(P>0.05);轻度组与重度组(P<0.05);中度组与重度组(P<0.05)。先天性心脏病、高胆红素血症、肺出血两两比较均无统计学意义(P>0.05)。低蛋白血症两两比较显示均有统计学意义(P<0.05)。三组患儿术后机械通气时间两两比较显示,轻度组与中度组比较(P<0.05);轻度组与重度组比较(P<0.05);中度组与重度组比较(P<0.05)。62例均行胸腔镜下手术,2例中转开胸手术(1例术中发现肠管血运差,1例裂孔修补困难)。轻度组19例患儿均痊愈;中度组患儿痊愈25例,家属放弃治疗1例,按死亡计算;重度组患儿痊愈15例,死亡2例。两两比较显示,轻度组与中度组比较(P>0.05);轻度组与重度组比较(P>0.05);中度组与重度组比较(P>0.05)。结论新生儿胸腹裂孔疝肺发育不良程度分为三组是可行有效的,肺动脉高压、肺炎、低蛋白血症等为主要并发症。围手术期采用肺保护性通气策略,病情稳定后再手术,可提高患儿生存率。Objective To explore the relationship between the degree of pulmonary dysplasia and prognosis in neonates with pleuroperitoneal foramen hernia.Methods To select 62 neonates with pleuroperitoneal foramen hernia admitted from June 2007 to June 2017 was set as the study objects.According to the time of symptom onset,blood gas analysis,CR/CT/MRI,lung compression volume,pulmonary artery pressure,and intraoperative double lungs expansion,the children patients were divided into three groups based on the degree of pulmonary dysplasia,including 19 cases in a mild group,26 cases in a moderate group,and 17 cases in a severe group.The perioperative lung protective ventilation strategy was adopted,and surgery was performed after the condition was stable.Results Through the comparison of the ages of the three groups of children patients in pairs,including the mild group was compared with the moderate group(P>0.05),the mild group was compared with the severe group(P<0.05),and the moderate group was compared with the severe group(P<0.05),the results showed that the pairwise comparisons of gender,onset side,and presence or absence of hernia sac showed no statistical significance(P>0.05).In terms of comorbidities,the pulmonary arterial hypertension were compared in pairs among the three groups of pulmonary dysplasia before surgery,the mild group was compared with the moderate group(P<0.05),the mild group was compared with the severe group(P<0.05),and the moderate group was compared with the severe group(P>0.05).As well as pairwise comparison of pneumonia and myocardial damage was performed between the mild group and the moderate group(P>0.05),the mild group and the severe group(P<0.05),and the moderate group and the severe group(P<0.05).The results showed that congenital heart disease,hyperbilirubinemia,and pulmonary hemorrhage were not statistically significant(P>0.05),and the pairwise comparison of hypoproteinemia showed statistical significance(P<0.05).The three groups of postoperative mechanical ventilationy time were compared

关 键 词：新生儿 胸腹裂孔疝 肺发育不良 外科手术 预后 

分 类 号：R473.72[医药卫生—护理学]