新生儿先天性膈疝预后相关因素分析  

Analysis of prognostic factors of neonatal congenital diaphragmatic hernia

作　　者：李海振 马立霜[2] 王莹[2] 刘超 魏延栋[2] 于斯淼 赵云龙 Li Haizhen;Ma Lishuang;Wang Ying;Liu Chao;Wei Yandong;Yu Simiao;Zhao Yunlong(Capital Institute of Pediatrics,Peking University Teaching Hospital,Beijing 100020,China;Department of Neonatal Surgery,Affiliated Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China;Department of Neonatal Surgery,Peking Union Medical College,Chinese Academy of Medical Sciences,Capital Institute of Pediatrics,Affiliated Children's Hospital,Beijing 100020,China)

机构地区：[1]北京大学首都儿科研究所教学医院,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]中国医学科学院协和医学院,首都儿科研究所附属儿童医院新生儿外科,北京100020

出　　处：《临床小儿外科杂志》2022年第5期458-462,共5页Journal of Clinical Pediatric Surgery

基　　金：北京市儿科学科协同发展中心儿科专项基金资助项目(XTZD20180305);国家重点研发计划基金资助项目(2018YFC1002503);北京市卫生与健康科技成果和适宜技术推广项目基金资助项目(2018-TG-51)。

摘　　要：目的总结首都儿科研究所附属儿童医院近6年来诊治的新生儿先天性膈疝(congenital diaphragmatic hernia,CDH)患儿临床资料,探讨新生儿先天性膈疝预后不良的相关因素。方法回顾性分析2014年4月至2020年7月北京大学首都儿科研究所教学医院收治的73例先天性膈疝患儿临床资料。按照预后情况分为预后良好组(术后顺利出院且存活,54例)和预后不良组(术后死亡,19例),收集两组患儿的临床资料(包括性别、出生孕周是否<37周、出生体重是否<2.5 kg、诊断胎龄是否≤25周、手术方式、手术时间是否<出生后24 h、手术时长是否<180 min、肝脏位置、出生孕周、手术时长)。采用多因素Logistic回归分析患儿预后不良的相关因素。结果接受治疗的73例CDH患儿中,男46例,女27例;左侧58例,右侧15例;63例获得产前诊断,10例因生后呼吸窘迫经胸片确诊;存活54例(54/73,73.9%),死亡19例(19/73,26.1%)。54例痊愈出院患儿出院时指导家长进行肺功能训练及门诊定期复查,均获得门诊或电话随访,平均随访2.78年。出院后90 d、1年、2年、5年存活率均为100%。多因素Logistic回归分析结果显示,低出生体重、生后24 h内接受手术、开放手术方式、诊断胎龄≤25周是新生儿先天性膈疝预后不良的相关因素(P<0.05)。结论低出生体重、诊断胎龄≤25周、出生后24 h内手术可能与新生儿先天性膈疝预后不良有关。Objective To summarize the clinical features of neonatal congenital diaphragmatic hernia(CDH)treated at a single center over the last 6 years and explore the related factors of poor prognosis.Methods From April 2014 to July 2020,clinical data were retrospectively reviewed for 73 CDH children.According to the prognosis,they were divided into two groups of good prognosis(54 survivors)and poor prognosis(19 deaths).The clinical data of children in two groups were collected,including gender,whether or not gestational week of birth<37 weeks,birth weight<2.5 kg,gestational age of diagnosis≤25 weeks,surgical approach,operative duration<24h after birth,operative duration<180 min,liver position,hernia position,gestational week of birth and operative duration.Multivariate Logistic regression was employed for examining the related factors of poor prognosis.Results There were 46 boys and 27 girls.The involved side was left(n=58)and right(n=15).Sixty-three cases were detected through a prenatal diagnosis and 10 cases confirmed by chest radiography for postnatal respiratory distress.Fifty-four children(54/73,73.9%)survived and 19(19/73,26.1%)died.Fifty-four children were discharged from hospital after recovery and their parents were instructed to exercise lung function.During an average follow-up period of 2.78 years,outpatient or telephone follow-ups were performed.The survival rates of 90 d,1/2/5-year after discharge were 100%.Multivariate Logistic regression indicated that low birth weight,operation within 24h after birth,open operation and diagnosis of gestational age≤25 weeks were the related factors for poor prognosis(P<0.05).Conclusion Low birth weight,diagnosis of gestational age≤25 weeks and operation timing<24 h may be risk factors for poor prognosis of CDH.Thoracoscopic repair may be preferred if a surgeon is experienced.

关 键 词：疝 横膈 先天性 影响因素分析 婴儿 新生 疾病 预后 

分 类 号：R722.1[医药卫生—儿科]