先天性膈疝患儿手术后近期肺功能观察及相关因素分析  

Clinical observation of recent postoperative pulmonary function in patients with congenital phrenic hernia

作　　者：张奕[1] 马立霜[2] 曹玲[1] 张悦[2] 宋欣[3] 王莹[2] 刘超 魏延栋[2] Zhang Yi;Ma Lishuang;Cao Ling;Zhang Yue;Song Xin;Wang Ying;Liu Chao;Wei Yandong(Department of respiratory medicine,children s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100200,China;Neonatal surgery of children s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100200,China;Pulmonary function room,Department of allergy,children s Hospital Affiliated to Capital Institute of Pediatrics,Beijing 100200,China)

机构地区：[1]首都儿科研究所附属儿童医院呼吸内科,北京100020 [2]首都儿科研究所附属儿童医院新生儿外科,北京100020 [3]首都儿科研究所附属儿童医院变态反应科肺功能室,北京100020

出　　处：《临床小儿外科杂志》2022年第3期236-241,共6页Journal of Clinical Pediatric Surgery

基　　金：国家重点研发计划(2018YFC1002503);北京市卫生与健康科技成果与适宜技术推广项目(BHTPP202005);北京市儿科学科协同发展中心儿科重点专项(XTZD20180305)。

摘　　要：目的 分析先天性膈疝(congenital diaphragmatic hernia, CDH)手术后患儿近期肺功能情况,探索影响肺功能的相关因素,以指导临床随访。方法 以2016年4月至2021年1月首都儿科研究所附属儿童医院新生儿外科收治的CDH患儿为研究对象,患儿均经手术修补治疗,并进行肺功能检查。肺功能检查时间中位数为术后1.6个月(最长18个月,最短11 d),按照肺功能结果分为肺功能正常组、肺功能异常组(包括阻塞性通气功能异常、限制性通气功能异常、混合性通气功能异常)。比较两组临床资料(包括产前诊断时间、肝脏疝入情况、缺损大小、手术时机、用氧时长等)的差异。结果 共32例CDH患儿纳入分析,其中肺功能正常5例(15.6%),肺功能异常27例(84.4%)。以第1次肺功能测定结果为准,阻塞性通气功能异常20例(62.5%),限制性通气功能异常3例(9.4%),混合性通气功能异常4例(12.5%)。肺功能正常组与肺功能异常组手术前肺动脉高压人数比例(2/5比23/27)、用氧时长[(12.22±6.09)d比(21.48±9.12)d]的差异具有统计学意义(P<0.05);出生后30 d用氧情况(1/5比18/27),差异无统计学意义(P>0.05)。产前诊断时间肺功能异常组的均值明显小于正常组,但差异无统计学意义[(30.67±3.51)周比(26.77±4.38)周,P>0.05]。结论 部分先天性膈疝患儿术后早期存在不同程度的肺功能异常,需予以高度重视。术后早期以阻塞性通气功能异常多见,肺动脉高压、用氧时长以及产前诊断时间可能是患儿肺功能异常的相关因素。Objective To analyze the recent postoperative lung function of children with congenital diaphragmatic hernia(CDH),and explore the risk factors affecting lung function to guide the clinical follow-up.Methods The clinical data of children undergoing CDH repair and lung function examination from April 2016 to January 2021 was retrospectively reviewed.According to the result of lung function exmination,they were divided into normal group and abnormal group(including obstructive ventilation dysfunction,restricted ventilation dysfunction and mixed ventilation dysfunction) and compared the intergroup differences.The mean time of lung function test was 1.6 months(11 days-18 months) after repair.Results Of the 32 cases of CDH children.5(15.6%) had normal pulmonary functionwhile other 27(84.4%) had adnormal pulmonary function.Subject to the result of the first lung function examination,20(62.5%) cases showed obstructive ventilation dysfunction,3(9.4%) cases showed restricted ventilation dysfunction,and 4(12.5%) cases showed mixed ventilation dysfunction.Both normal and abnormal groups had statistical differences in pulmonary artery hypertension(2/5 vs.23/27,P<0.05),oxygen duration[(12.22±6.09)d vs.(21.48±9.12)d,P<0.05].The oxygen use at 30 days after birth had no significant statistical significance.The mean of prenatal diagnosis time of abnormal group was significantly smaller than normal group,but there was no significant statistical difference [(30.67±3.51)w vs.(26.77±4.38)w,P>0.05].Conclusion Attention should be paid to CDH children who have different degrees of lung dysfunction early after surgery.Obstructive ventilation dysfunction is more common after CDH repair.Arterial hypertension and oxygen use duration may be risk factors for lung dysfunction.It is speculated that the prenatal diagnosis time may affect the lung function of children with CDH.

关 键 词：疝 横膈 先天性/外科学 治疗结果 呼吸功能试验 观察性研究 

分 类 号：R726.5[医药卫生—儿科]