早产及低出生体重先天性膈疝患儿的治疗  

Management of congenital diaphragmatic hernia in preterm and low birth weight infants

作　　者：刘超 王莹[1] 魏延栋[1] 马立霜[1] Chao Liu;Ying Wang;Yandong Wei;Lishuang Ma(Department of Pediatric and Neonatal Surgery,Children's Hospital,Capital Institute of Pediatrics,Beijing 100020,China)

机构地区：[1]首都儿科研究所附属儿童医院普通(新生儿)外科,北京100020

出　　处：《中华围产医学杂志》2023年第7期584-590,共7页Chinese Journal of Perinatal Medicine

基　　金：北京市自然科学基金(7224321)。

摘　　要：目的:分析早产及低出生体重的先天性膈疝(congenital diaphragmatic hernia,CDH)患儿的治疗情况,并总结相关治疗经验。方法:本研究为回顾性研究,选择2011年5月1日至2022年3月31日在首都儿科研究所附属儿童医院收治并行手术治疗的117例CDH新生儿,根据胎龄及出生体重分为早产和/或低出生体重组(胎龄<37周和/或出生体重<2500 g,41例)和对照组(胎龄≥37周且出生体重≥2500 g,76例),进一步将早产和/或低出生体重组患儿按照手术方式分为胸腔镜手术亚组(n=31)及开放手术亚组(n=10)。采用两独立样本t检验、秩和检验、χ^(2)检验或Fisher精确概率法对数据进行统计分析。结果:早产和/或低出生体重组患儿的1 min Apgar评分[7.0分(6.0~8.0分)与9.0分(8.0~9.8分),Z=-4.03]及5 min Apgar评分[9.0分(8.0~10.0分)与9.0分(9.0~10.0分),Z=-2.13]均低于对照组(P值均<0.05),中重度肺动脉高压患儿比例高于对照组[68.3%(28/41)与38.2%(29/76),χ^(2)=9.68,P<0.05]。2组患儿的胸腔镜手术比例、手术时长、右侧膈疝、疝囊、缺损分级、肝脏疝入和应用补片等术中情况差异均无统计学意义(P值均>0.05)。术后情况对比,早产和/或低出生体重组患儿的病死率高于对照组[36.6%(15/41)与13.2%(10/76),χ^(2)=8.70],术后恢复全肠内营养时间晚于对照组[25 d(18~29 d)与16 d(10~25 d),Z=2.31]。早产和/或低出生体重CDH患儿中胸腔镜手术亚组的病死率低于开放手术亚组[25.8%(8/31)与7/10],胸腔镜手术亚组的生后1 min Apgar评分较高[(7.4±1.6)分与(6.0±2.2)分,t=2.20],手术时龄较大[31.0 h(23.0~48.0 h)与17.0 h(4.7~24.5 h),Z=2.57],生后24 h内手术患儿的比例更低[32.3%(10/31)与8/10],手术时间更长[170.0 min(122.0~200.0 min)与110.0 min(87.3~120.0 min),Z=3.65]。结论:早产和/或低出生体重CDH患儿病死率较高,可能与中重度肺动脉高压患儿比例偏高有关。对于呼吸循环功能相对稳定的早产及低出生体重患儿,可以Objective To investigate the treatment of preterm and low birth weight infants with congenital diaphragmatic hernia(CDH)and to share the experience.Methods This retrospective study enrolled 117 newborns with CDH who underwent major surgery at Children's Hospital,Capital Institute of Pediatrics from May 1,2011,to March 31,2022.Based on gestational age and birth weight,the infants were divided into the preterm and/or low birth weight group(gestational age<37 weeks and/or birth weight less than 2500 g,n=41)and the control group(gestational age≥37 weeks and birth weight≥2500 g,n=76).Furthermore,the preterm and/or low birth weight infants were divided into the thoracoscopic surgery subgroup(n=31)and the open surgery subgroup(n=10)according to the surgical approach.Statistical analysis of the data was performed using two independent sample t-tests,rank sum tests,Chi-square test,or Fisher's exact probability test.Results Preoperative data showed that the Apgar scores at 1 min[7.0(6.0-8.0)vs 9.0(8.0-9.8),Z=-4.03]and 5 min[9.0(8.0-10.0)vs 9.0(9.0-10.0),Z=-2.13]of the preterm and/or low birth weight infants were both lower than those in the control group(both P<0.05),while the proportion of infants with moderate to severe pulmonary hypertension was higher[68.3%(28/41)vs 38.2%(29/76),χ^(2)=9.68,P<0.05].There were no statistically significant differences between the two groups in terms of the proportion of thoracoscopic surgery,operation time,right diaphragmatic hernia,presence of hernia sac,grading of the defect,presence of liver herniation,and application of mesh(all P>0.05).Regarding the postoperative outcomes,the death rate in the preterm and/or low birth weiht group was higher compared to the control group[36.6%(15/41)vs 13.2%(10/76),χ^(2)=8.70,P<0.05].Additionally,the time required to resume full enteral nutrition after surgery was longer in the preterm and/or low birth weight group than that in the control group[25 d(18-29 d)vs 16 d(10-25 d),Z=2.31,P<0.05].The thoracoscopic subgroup had a lower mortality compare

关 键 词：疝 横膈 先天 胸腔镜检查 婴儿 早产 婴儿 出生低体重 

分 类 号：R722.6[医药卫生—儿科]