先天性膈疝围产期诊疗一体化模式分析

发布时间：2018-08-11 12:21

【摘要】：目的 :探讨先天性膈疝(congenital diaphragmatic hernia,CDH)的产前诊断、围产期精细化管理、产后手术治疗的围产期诊疗一体化模式的有效性。方法:回顾性分析2014年1月—2016年12月本院8例CDH,经产前诊断、围产期精细化管理、产后手术治疗并随访的临床资料。结果:在孕22~32周筛查发现CDH,随后行MRI检查,同时排除染色体异常。8例出生胎龄37~40周,出生体重2.50~3.55 kg,男6例,女2例,均在产房或手术室,在维持胎儿胎盘循环状态下清理呼吸道、气管插管、放置胃管及胃肠减压,后断脐行进一步处理及转入小儿心胸外科ICU,床边胸片、血气分析结合生命体征监测,待病情稳定后手术治疗,8例均存活。术后呼吸机使用时间20 h~10 d,3例左肺发育不良患儿反复气管插管;4例术后胸腔积液,其中1例为乳糜胸引流2周后痊愈;1例合并漏斗胸在3岁时行漏斗胸微创矫正术(NUSS术),还有1例漏斗胸随访中;1例室间隔缺损伴肺动脉高压在10个月时行室间隔缺损修补术;1例胆总管囊肿在6个月时因胆道梗阻行胆管引流术。随访中患儿生长发育正常。结论:应用先天性膈疝围产期诊疗一体化模式可以有效降低患儿医疗风险,提高救治成功率。
[Abstract]:Objective: to investigate the effectiveness of prenatal diagnosis, perinatal fine management and postpartum surgical treatment of congenital diaphragmatic hernia. Methods: the clinical data of 8 cases of CDHs in our hospital from January 2014 to December 2016 were retrospectively analyzed, including prenatal diagnosis, perinatal fine management, postpartum surgical treatment and follow-up. Results: CDHs were detected at 2232 weeks of gestation, and then MRI was performed. At the same time, the gestational age of 8 cases with chromosomal abnormalities was excluded. The birth weight was 2.50 ~ 3.55 kg, 6 males and 2 females, all of them were in the labor room or operating room. Under the condition of maintaining fetal placenta circulation, respiratory tract was cleared, tracheal intubation was placed, gastric tube and gastrointestinal decompression were placed, and further treatment of posterior umbilical cord was performed. ICU, bedside chest film, blood gas analysis combined with vital signs monitoring were carried out in pediatric cardiothoracic surgery. All the 8 cases survived after operation after stable condition. Postoperative ventilator was used for 20 hours and 10 days after operation in 3 children with left lung dysplasia, 4 patients with postoperative pleural effusion were intubated repeatedly by tracheal intubation. One case was cured after 2 weeks of chylothorax drainage, 1 case was treated with funnel chest minimally invasive orthodontics (NUSS) at the age of 3 years, and 1 case was followed up with ventricular septal defect with pulmonary hypertension at 10 months. One case of choledochal cyst underwent biliary drainage for 6 months due to biliary obstruction. During the follow-up, the growth and development of the children were normal. Conclusion: the integrated diagnosis and treatment of congenital diaphragmatic hernia during perinatal period can effectively reduce the medical risk and improve the success rate.
【作者单位】：南京医科大学第一附属医院小儿心胸外科;
【分类号】：R726.5

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