Cacciari A, Ruggeri G, Mordenti M, Ceccarelli P L, Baccarini E, Pigna A, Gentili A
Department of Paediatric Surgery, University of Bologna, Italy.
Eur J Pediatr Surg. 2001 Feb;11(1):3-7. doi: 10.1055/s-2001-12204.
Newborns affected by congenital diaphragmatic hernia (CDH) are high-risk patients: today the mortality is still elevated and is essentially due to severe pulmonary hypoplasia, pulmonary hypertension and the absence of surfactant. High-Frequency Oscillatory Ventilation (HFOV) seems to be a good pre- and postoperative technique in cases of CDH.
We report our experience in the treatment of CDH; since 1987 we have followed 44 patients. We divided them into two different groups in accordance with the ventilation technique used: Group I (1987-1994): 25 patients treated with conventional mechanical ventilation (CMV); Group II (1994-1997): 19 patients treated with HFOV used since the first day of life until clinical stabilisation and also prolonged during surgery and in the postoperative period.
37 patients (84%) underwent surgery with closure of the diaphragmatic defect. We had a very good improvement in survival, rising from 67% (CMV) to 94% (HFOV) of the patients operated on, reaching an overall survival of 56% vs 79%.
The use of HFOV for the treatment of CDH has proved to be a valuable technique for pre-operative stabilisation and for intra- and postoperative respiratory treatment, above all for newborns with CDH.
患有先天性膈疝（CDH）的新生儿属于高危患者：如今其死亡率仍然很高，主要原因是严重的肺发育不全、肺动脉高压以及缺乏表面活性物质。高频振荡通气（HFOV）似乎是治疗CDH的一种很好的术前和术后技术。
我们报告了我们在治疗CDH方面的经验；自1987年以来，我们随访了44例患者。我们根据所使用的通气技术将他们分为两个不同的组：第一组（1987 - 1994年）：25例患者采用传统机械通气（CMV）治疗；第二组（1994 - 1997年）：19例患者从出生第一天起就使用HFOV治疗，直至临床稳定，并且在手术期间和术后也持续使用。
37例患者（84%）接受了手术，关闭了膈缺损。我们在生存率方面有了非常显著的提高，接受手术的患者生存率从67%（CMV）提高到了94%（HFOV），总体生存率分别为56%和79%。
事实证明，使用HFOV治疗CDH是一种有价值的技术，可用于术前稳定以及术中及术后的呼吸治疗，尤其是对于患有CDH的新生儿。
