优化围手术期临床管理策略对先天性膈疝诊治疗效的影响

发布时间：2018-04-15 02:40

本文选题：先天性膈疝 + 优化管理　；参考：《临床儿科杂志》2017年09期

【摘要】：目的探讨膈疝产前诊断后规范化处理及技术流程的优化改进对先天性膈疝(CDH)诊治的影响。方法回顾分析2005年1月到2016年8月入住新生儿重症监护室、诊断为CDH的新生儿病例临床资料。依据规范化处理实施时间,将2010年1月至2016年8月收治的93例CDH作为干预组,2005年1月至2009年12月收治的15例CDH作为对照组,比较两组生存率、并发症等临床结局。结果两组患儿在性别、出生胎龄、出生体质量、Apgar评分和CDH位置方面的差异均无统计学意义(P0.05);干预组的总存活率为81.7%,对照组为53.3%,差异有统计学意义(P0.05);两组的机械通气模式和气胸发生率的差异也均有统计学意义(P0.05);对照组的中位手术时间为4.5 h,干预组为49.5 h,术后存活率对照组为61.5%,干预组为90.5%,两组差异均有统计学意义(P0.05);两组死亡病例的首次血气分析显示,p H值和PCO2值的差异均有统计学意义(P0.05)。结论优化膈疝围手术期的临床处理对提高CDH的存活率以及减少并发症有积极的促进作用,干预组死亡病例存在更严重的肺发育不良。
[Abstract]:Objective to investigate the effect of standardized management of diaphragmatic hernia after prenatal diagnosis and optimization of technical process on the diagnosis and treatment of congenital diaphragmatic hernia (CDH).Methods the clinical data of neonates admitted to neonatal intensive care unit (NICU) and diagnosed as CDH from January 2005 to August 2016 were retrospectively analyzed.According to the time of standardized treatment, 93 cases of CDH from January 2010 to August 2016 were treated as intervention group and 15 cases of CDH admitted from January 2005 to December 2009 as control group. The survival rate and complications were compared between the two groups.Results there were two groups of children in gender, gestational age at birth,There was no significant difference in birth weight Apgar score and CDH position between the two groups; the total survival rate was 81.7 in the intervention group and 53.3 in the control group, and there was significant difference between the two groups in the mode of mechanical ventilation and the incidence of pneumothorax.The median operation time was 4.5 hours in the control group, 49.5 hours in the intervention group, 61.5 in the control group and 90.5 in the intervention group.There was significant difference between the PCO2 and the value of PCO2 (P 0.05).Conclusion optimizing the clinical management of diaphragmatic hernia during perioperative period can improve the survival rate of CDH and reduce complications. The death cases in intervention group have more severe pulmonary dysplasia.
【作者单位】：上海交通大学医学院附属新华医院新生儿科;上海交通大学医学院附属新华医院儿外科;上海交通大学医学院附属新华医院产科;
【分类号】：R722.1

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