先天性膈疝患儿早期肺泡动脉氧分压差对临床结局的预测价值  

Clinical values of alveolar-arterial oxygen difference in arterial blood gas early after birth in evaluating the outcomes of neonatal congenital diaphragmatic hernia

作　　者：夏波 吕俊健 何秋明 程映 钟微 赵培智 Xia Bo;Lyu Junjian;He Qiuming;Cheng Ying;Zhong Wei;Zhao Peizhi(Department of Surgical Neonatal Intensive Care Unit,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangzhou 510623,China)

机构地区：[1]广州医科大学附属妇女儿童医疗中心新生儿外科重症监护室,广州510623

出　　处：《中华新生儿科杂志（中英文）》2024年第12期711-716,共6页Chinese Journal of Neonatology

基　　金：广东省自然科学基金项目(2020A1515010296)。

摘　　要：目的探讨新生儿早期动脉血肺泡-动脉氧分压差(alveolar-arterial difference in oxygen pressure,AaDO_(2))预测先天性膈疝(congenital diaphragmatic hernia,CDH)患儿需要体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持的预测价值,以及AaDO_(2)与临床结局之间的关系。方法收集2016年1月至2024年2月广州医科大学附属妇女儿童医疗中心新生儿外科监护病房收治的新生儿CDH的临床资料进行回顾性分析,根据是否达到ECMO支持指征分为需ECMO组和不需ECMO组,比较两组患儿临床资料差异,采用多因素回归分析需ECMO支持的危险因素,并绘制生后6 h内AaDO_(2)预测需要ECMO支持的受试者工作特征曲线,根据截断值分为高AaDO_(2)组和低AaDO_(2)组,应用Kaplan-Meier生存曲线、t检验比较两组患儿肺发育不良发生率和病死率的差异。结果共纳入186例患儿,需ECMO组43例、不需ECMO组143例,多因素回归分析显示生后6 h内AaDO_(2)增高是CDH患儿需要ECMO支持的独立危险因素(OR=1.058,95%CI 1.030~1.087,P<0.05)。受试者工作特征曲线分析显示,AaDO_(2)预测CDH是否需要ECMO支持的最佳截点为32.2 kPa,曲线下面积为0.805(95%CI 0.705~0.906)。根据AaDO_(2)截断值,分为高AaDO_(2)组48例和低AaDO_(2)组127例,两组比较,高AaDO_(2)组需要ECMO支持率(66.7%比8.7%)、合并慢性肺疾病率(46.2%比9.2%)、高风险缺损率(C/D级缺损)(55.9%比11.6%)明显高于低AaDO_(2)组,存活率(54.2%比93.7%)明显低于低AaDO_(2)组,差异均有统计学意义(P<0.05);高AaDO_(2)组存活患儿中位住院时间明显长于低AaDO_(2)组[32.5(19.8,64.5)d比17.0(12.0,24.0)d,P<0.05]。结论CDH患儿生后6 h内动脉血AaDO_(2)增高是预测是否需要ECMO治疗的独立危险因素,高AaDO_(2)患儿呼吸系统相关疾病发病率和病死率较高,可作为判断新生儿CDH预后的指标之一。ObjectiveTo study the clinical values of alveolar-arterial difference in oxygen pressure(AaDO_(2))in arterial blood gas(ABG)early after birth in predicting the need for extracorporeal membrane oxygenation(ECMO)and evaluating clinical outcomes in neonates with congenital diaphragmatic hernia(CDH).MethodsFrom January 2016 to February 2024,patients with neonatal CDH admitted to our hospital were retrospectively reviewed.They were assigned into ECMO group and non-ECMO group according to ECMO indications.The data of the two groups were compared and multivariate regression analysis was used to analyze the risk factors of ECMO.Receiver operating characteristic(ROC)curve of AaDO_(2) predicting ECMO requirement within 6 h after birth was drawn.The patients were further assigned into high-AaDO_(2) group and low-AaDO_(2) group and the differences of morbidities and mortalities were compared.ResultsA total of 186 cases were enrolled,including 43 in the ECMO group and 143 in the non-ECMO group.Multivariate regression analysis showed that elevated AaDO_(2) within 6 h after birth an independent risk factor for ECMO in CDH patients(OR=1.058,95%CI 1.030-1.087,P<0.05).ROC curve analysis revealed the optimal AaDO_(2) threshold was 32.2 kPa with the area under the curve(AUC)0.805(95%CI 0.705-0.906).The incidences of pulmonary hypertension requiring ECMO,chronic lung disease and high-risk diaphragmatic defects(grade C/D defects)in high-AaDO_(2) group were 66.7%,46.2%and 55.9%,respectively,significantly higher than low-AaDO_(2) group(8.7%,9.2%and 11.6%,all P<0.05).The survival rate of high-AaDO_(2) group was significantly lower than low-AaDO_(2) group(54.2%vs.93.7%,P<0.05).The median length of hospital stay of the survivors in high-AaDO_(2) group was significantly longer than low-AaDO_(2) group(32.5 d vs.17.0 d,P<0.05).ConclusionsEarly AaDO_(2) is an independent risk factor predicting the need of ECMO in neonates with CDH.Patients with high AaDO_(2) have higher incidences of adverse respiratory morbidities and overall mortalities.High

关 键 词：新生儿 先天性膈疝 血气分析 预后 

分 类 号：R725.6[医药卫生—儿科]