Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study
Risk factors for pneumothorax associated with isolated congenital diaphragmatic hernia: results of a Japanese multicenter study
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DOI：
10.1007/s00383-020-04659-3
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发表时间：
2020-04-28
影响因子：
1.8
通讯作者：
Taguchi, Tomoaki
中科院分区：
文献类型：
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作者：
Masahata, Kazunori;Usui, Noriaki;Taguchi, Tomoaki
目的探讨新生儿先天性腹股沟疝（CDH）合并气胸的临床特点，分析其发生气胸的危险因素。方法对日本CDH研究组的15个机构进行回顾性队列研究。本研究共分析了2011年至2018年期间出生的495例孤立性CDH新生儿。结果495例新生儿单纯CDH中，52例（10.5%）发生气胸。18例（34.6%）患者术前发生气胸，34例（65.4%）患者术后发生气胸。log-rank检验显示气胸患者的累积生存率显著低于无气胸患者。单因素分析显示，气胸患者和无气胸患者在出生后24小时内的最佳氧合指数、平均气道压（MAP）高于16 cmH（2）O、肺缺损大小和是否需要补片缝合方面存在显著差异。多因素Logistic回归分析表明，只有MAP与气胸风险增加相关。结论单纯CDH合并气胸患者的累积生存率明显低于无气胸患者。较高的MAP是CDH患者发生气胸的危险因素。
Purpose This study aimed to elucidate the clinical characteristics of neonates with congenital diaphragmatic hernia (CDH) associated with pneumothorax and evaluate the risk factors for the development of pneumothorax. Methods A retrospective cohort study was conducted in the 15 institutions participating in the Japanese CDH Study Group. A total of 495 neonates with isolated CDH who were born between 2011 and 2018 were analyzed in this study. Results Among the 495 neonates with isolated CDH, 52 (10.5%) developed pneumothorax. Eighteen (34.6%) patients developed pneumothorax before surgery, while 34 (65.4%) developed pneumothorax after surgery. The log-rank test showed that the cumulative survival rate was significantly lower in patients with pneumothorax than in those without pneumothorax. Univariate analysis revealed significant differences between patients with pneumothorax and those without pneumothorax with regard to the best oxygenation index within 24 h after birth, mean airway pressure (MAP) higher than 16 cmH(2)O, diaphragmatic defect size, and need for patch closure. Multiple logistic regression analysis indicated that only the MAP was associated with an increased risk of pneumothorax. Conclusions The cumulative survival rate was significantly lower in isolated CDH patients with pneumothorax than in those without pneumothorax. A higher MAP was a risk factor for pneumothorax in CDH patients.