Congenital diaphragmatic hernia: experience without extracoporeal membrane oxygenation
Congenital diaphragmatic hernia: experience without extracoporeal membrane oxygenation
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DOI：
10.1007/s003830200006
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发表时间：
2002-01-01
影响因子：
1.8
通讯作者：
Henteleff, H
中科院分区：
文献类型：
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作者：
Al-Shanafey, S;Giacomantonio, M;Henteleff, H
虽然体外膜肺氧合（ECMO）用于治疗先天性腹股沟疝（CDH），但其价值受到质疑。回顾过去27年来所有因先天性心脏病而出现呼吸窘迫的新生儿病历。对先天与外生、修复年份、超声（US）的使用以及各种参数的预测价值进行评价。采用Fisher精确检验和Logistic回归分析数据。共有81名患者。43名男性和38名女性。在无ECMO的情况下稳定后进行修复; 65例患者存活（80%）。1 min（P = 0.03）和5 min（P = 0.005）时的Apgar评分、最佳导管后PaO 2（BPDPaO 2）（P = 0.02）和修复类型（P = 0.01）可预测结局。在回顾的几年中，先天性和外生性患者的生存率没有差异（P = 0.29）。46例患者记录了产前超声扫描，对结局无明显影响。因此，没有ECMO的CDH患者的生存率与ECMO报告的最佳结果相当，这表明ECMO的成本和相关的发病率可能不足以证明其用于此类患者。Apgar评分、BPDPaO 2和修复类型是良好的预后预测因子。虽然相对罕见，但新生儿CDH（特别是那些产前未诊断的新生儿）的戏剧性表现使其成为儿科外科领域最具挑战性的问题之一。在过去的几十年中，CDH管理的许多方面都发生了变化，最受欢迎的选择之一是体外膜肺氧合（ECMO）。虽然ECMO用于CDH的管理，并且被一些人认为是此类患者最重要的新兴疗法[1-4]，但其价值仍存在疑问。这表明ECMO可以通过最大限度地减少持续性肺动脉高压来提高生存率[5，6]。然而，肺发育不良的影响加上与ECMO相关的严重并发症，导致一些观察者得出结论，ECMO对生存率没有总体积极影响[7，8]。本研究回顾了我们过去27年来在不使用ECMO的情况下管理CDH的经验。我们的目标是：（1）确定我们中心的CDH生存率，（2）检查CDH生存率在回顾期内是否发生变化，（3）确定该组患者生存率的重要预测因素。
While extracorporeal membrane oxygenation (ECMO) is used in the management of congenital diaphragmatic hernia (CDH), its value is questioned. The charts of all newborn infants who presented in respiratory distress due to CDH over the past 27 years were reviewed. Inborn versus outborn, year of repair, use of ultrasound (US), and the predictive value of various parameters was evaluated. Fisher's exact test and logistic regression tests were used to analyze data. There were 81 patients. 43 males and 38 females. Repair occurred after stabilization without ECMO; 65 patients survived (80%). Apgar scores at 1 min (P = 0.03) and 5 min (P = 0.005), best postductal PaO2 (BPDPaO2) (P = 0.02), and type of repair (P = 0.01) were predictive of outcome. There was no difference in survival between inborn and outborn patients or over the years of review (P = 0.29). Forty-six patients had documented prenatal US scans, with no obvious impact on outcome. Thus, survival of CDH patients without ECMO is comparable to the best results reported with ECMO, suggesting that the costs and associated morbidity of ECMO may not justify its use for such patients. Apgar scores, BPDPaO2, and type of repair are good predictors of outcome. Although relatively rare, the dramatic presentation of newborns with CDH (especially those not diagnosed prenatally) makes it one of the most challenging problems in the field of pediatric surgery.In the last few decades many aspects of CDH management have changed, and one of the most popular options is extracorporeal membrane oxygenation (ECMO). While ECMO is used in the management of CDH and considered by some to be the most important emerging therapy for such patients [1-4], its value is still in question. It is suggested that ECMO can improve survival by minimizing persistent pulmonary hypertension [5, 6]. However the impact of pulmonary hypoplasia coupled with significant complications associated with ECMO has led some observers to conclude that ECMO has no overall positive impact on survival [7, 8]. This study reviewed our experience with management of CDH without ECMO over the past 27 years. Our goals were: (1) to define CDH survival at our center, (2) to examine whether CDH survival changed over the period of review, and (3) to determine significant predictors of survival in this group of patients.