Impact of our new protocol on the outcome of the neonates with congenital diaphragmatic hernia
Impact of our new protocol on the outcome of the neonates with congenital diaphragmatic hernia
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DOI：
10.1007/s00383-012-3242-z
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发表时间：
2013-04-01
影响因子：
1.8
通讯作者：
Tajiri, Tatsuro
中科院分区：
文献类型：
--
作者：
Kimura, Osamu;Furukawa, Taizo;Tajiri, Tatsuro
先天性腹股沟疝（CDH）仍然是小儿外科医生面临的挑战。自2003年以来，我们开发了一种新的协议，旨在获得更好的结果。本研究将46例出生24 h以内的先天性心脏病新生儿按年龄和治疗方案的不同分为两组，对两组的治疗效果进行了评价。在第1组中，15例患者在1997年至2002年期间接受治疗，第2组中31例患者在2003年至2011年期间接受治疗。在后一组中，引入了一种新的方案，重点是通过类固醇给药预防肺水肿和肺损伤，并通过持续输注d-甘露醇稳定心肺功能。比较两组的生存率和术后插管时间，总生存率由53%（8/15）提高到81%（25/31）（p < 0.05）。在孤立性CDH中，存活率从58%增加到93%。平均POIP由39.0天缩短至4.4天（P < 0.01），明显提高了CDH患儿的生存率，缩短了机械通气时间。
Congenital diaphragmatic hernia (CDH) remains a defiant challenge for pediatric surgeons. Since 2003, we developed a new protocol aiming for the better outcome. In this study, the usefulness of our new protocol was evaluated.Forty-six neonates with CDH at the age of less than 24 h were divided into two groups based on the difference of era and treatment protocols. In Group 1, 15 patients were treated between 1997 and 2002 and 31 patients were treated between 2003 and 2011 in Group 2. In the latter group, a new protocol was introduced focusing on the prevention of lung edema as well as lung injury by steroid administration and on the stabilization of cardiopulmonary function using continuous d-mannitol infusion. The survival rate and the postoperative intubation period (POIP) were compared between the two groups.The overall survival rate was significantly increased from 53 % (8/15) to 81 % (25/31) (p < 0.05). In isolated CDH, the survival rate was increased from 58 to 93 %. The average POIP was remarkably shortened from 39.0 to 4.4 days (p < 0.01).Our new protocol remarkably improved the survival rate and shortened the period of mechanical ventilation in neonates with CDH.