Congenital diaphragmatic hernia: onset of respiratory distress and size of the defect - Analysis of the outcome in 104 neonates
Congenital diaphragmatic hernia: onset of respiratory distress and size of the defect - Analysis of the outcome in 104 neonates
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DOI：
10.1007/s00383-006-1788-3
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发表时间：
2007-01-01
影响因子：
1.8
通讯作者：
Snajdauf, J.
中科院分区：
文献类型：
--
作者：
Rygl, Michal;Pycha, K.;Snajdauf, J.
本研究的目的是评价出生后24小时内或产前诊断的先天性腹股沟疝（CDH）新生儿的结局。该研究特别关注呼吸窘迫发作的时间和使用Gore-Tex（GT）补片进行血管重建。对104例新生儿先天性心脏病进行回顾性分析。采用方差分析、Kruskal-Wallis检验或卡方检验（如适用）对数据进行分析。结果表明，全组总生存率为73.1%（76/104）。手术新生儿存活率为91.6%（76/83）。出生后1分钟内发生呼吸窘迫的新生儿存活率为67%，2 ~ 10分钟内发生呼吸窘迫的新生儿存活率为89%，10分钟后发生呼吸窘迫的新生儿存活率为100%（P = 0.007）。出生体重、胎龄、呼吸窘迫发作时间和Apgar评分在存活者和死亡者之间存在显著差异。62例患者进行了血管缺损的一期闭合，21例患者使用了GT补片。采用GT补片治疗的大缺损患者的生存率较低（76.2% vs. 96.8%，P = 0.003）。在我们的GT补片系列中只有一例复发。存活率取决于呼吸窘迫发作的时间和缺损的大小，这两者都与肺发育不良的程度有关。术语高危CDH仅适用于出生后10分钟内发生呼吸窘迫的儿童和产前诊断的儿童。GT补片是一种合适的材料，用于胸壁重建;我们认为复发是由于补片与胸壁的不正确连接造成的。
The purpose of this study was to evaluate the outcome in neonates with congenital diaphragmatic hernia (CDH) either presenting within the first 24 h of life or diagnosed prenatally. The study was particularly focused on the time of onset of respiratory distress and on the use of the Gore-Tex (GT) patch for diaphragmatic reconstruction. Records of 104 neonates with CDH were retrospectively reviewed. The data were analyzed by ANOVA, Kruskal-Wallis test or chi(2) test as appropriate. The result showed that the overall survival rate was 73.1% (76/104). Survival of operated neonates was 91.6% (76/83). Postnatally diagnosed neonates with the onset of respiratory distress within the first minute of life survived in 67%, with the onset between 2 and 10 min survived in 89%, whilst neonates with the onset of respiratory distress after l0 min survived in 100% (P = 0.007). Birth weight, gestational age, time of onset of respiratory distress and Apgar score significantly differed between survivors and nonsurvivors. Primary closure of the diaphragmatic defect was performed in 62 patients while the GT patch was used in 21 patients. The survival of patients with a large defect treated with a GT patch was lower (76.2 vs. 96.8%, P = 0.003). There was only one case of recurrence in our series with the GT patch. Survival depends on the time of onset of respiratory distress and size of the defect, both of which correlate with the degree of pulmonary hypoplasia. The term high-risk CDH is appropriate only for children with respiratory distress within the first 10 min of life and those diagnosed prenatally. The GT patch is a suitable material for the diaphragmatic reconstruction; we suppose that the recurrence is caused by incorrect attachment of the patch to the thoracic wall.