Schoeman L, Pierro A, Macrae D, Spitz L, Kiely E M, Drake D P
Department of Paediatric Surgery, Institute of Child Health and Great Ormond Street Hospital for Children, London, England.
J Pediatr Surg. 1999 Feb;34(2):357-9. doi: 10.1016/s0022-3468(99)90209-9.
The aim of this study was to determine the long-term outcome of neonates who required extracorporeal membrane oxygenation (ECMO) for respiratory insufficiency associated with congenital diaphragmatic hernia (CDH).
All neonates born with CDH, who required ECMO (oxygenation index over 40 in the presence of maximal support) during a 6-year period, were reviewed. The median duration of follow-up for survivors was 14 months (range, 9 to 22 months).
Of 72 neonates with CDH, 11 (15%) required ECMO. The median age at the start of ECMO was 2 days (range, 1 to 4); duration was 9 days (range, 4 to 17); post-ECMO ventilation was 27 days (range, 8 to 86); and stay in intensive care unit, 33 days (range, 8 to 133). Three patients survived and are not oxygen dependent. There were three early deaths at 9 to 16 days and five late deaths at a median of 6 months (range, 2 to 32 months) secondary to chronic lung disease (n = 3) and infection (n = 2). Four of the five patients with late deaths were oxygen dependent at discharge from hospital. Three of the late death patients and one survivor underwent a fundoplication for gastrooesophageal reflux.
Neonates born with CDH and requiring ECMO had a significant late mortality. Follow-up for more than 1 year is indicated to assess the benefit of ECMO for this diagnosis. The authors report only three long-term survivors from 11 ECMO patients selected from a total of 72 neonates with CDH.
本研究旨在确定因先天性膈疝（CDH）相关呼吸功能不全而需要体外膜肺氧合（ECMO）的新生儿的长期预后。
回顾了在6年期间所有患有CDH且需要ECMO（在最大支持下氧合指数超过40）的新生儿。幸存者的中位随访时间为14个月（范围9至22个月）。
72例CDH新生儿中，11例（15%）需要ECMO。开始ECMO时的中位年龄为2天（范围1至4天）；持续时间为9天（范围4至17天）；ECMO后通气时间为27天（范围8至86天）；在重症监护病房的停留时间为33天（范围8至133天）。3例患者存活且不依赖氧气。有3例早期死亡发生在9至16天，5例晚期死亡发生在中位时间6个月（范围2至32个月），主要原因是慢性肺病（n = 3）和感染（n = 2）。5例晚期死亡患者中有4例出院时依赖氧气。3例晚期死亡患者和1例幸存者因胃食管反流接受了胃底折叠术。
患有CDH且需要ECMO的新生儿有显著的晚期死亡率。建议进行超过1年的随访以评估ECMO对该诊断的益处。作者报告在总共72例CDH新生儿中选择的11例接受ECMO治疗的患者中只有3例长期存活。
