Okazaki Tadaharu, Okawada Manabu, Shiyanagi Satoko, Shoji Hiromichi, Shimizu Toshiaki, Tanaka Toshitaka, Takeda Satoru, Kawashima Kazunari, Lane Geoffrey J, Yamataka Atsuyuki
Department of Pediatric Surgery, Juntendo University School of Medicine, 2-1-1 Hongo, Bunkyo-Ku, Tokyo, 113-8421, Japan.
Pediatr Surg Int. 2008 Dec;24(12):1369-73. doi: 10.1007/s00383-008-2266-x.
To determine if pulmonary artery size and blood flow have prognostic value in congenital diaphragmatic hernia (CDH).
Twenty-eight consecutive left-sided CDH patients treated according to a standard protocol with high frequency oscillatory ventilation (HFOV) + nitric oxide (NO) had right and left pulmonary artery (RPA, LPA) diameters, LPA/RPA diameter (L/R) ratios, and PA blood flows examined by echocardiography (EC) on days 0, 2, and 5 after birth and compared prospectively.
Twenty-two patients (78.6%) survived. Of these, 15 required NO (NO-s), and seven did not (non-NO-s). All six patients that died required NO (NO-d). RPA in the NO-d group was significantly smaller than in the NO-s or non-NO-s groups on day 0 (2.90 +/- 0.41 vs. 3.40 +/- 0.49 or 4.01 +/- 0.43; P < 0.01, respectively). LPA in the NO-d group was significantly smaller than in the non-NO-s on day 0 (2.13 +/- 0.45 vs. 3.39 +/- 0.34; P < 0.01). L/R ratios in NO subjects were significantly smaller (NO-s 0.74 +/- 0.11; NO-d 0.73 +/- 0.11) than in non-NO-s subjects (0.84 +/- 0.03) on day 0 (P < 0.01). PA diameters and L/R ratios did not change significantly from day 0 to day 5 in all three groups. There was LPA flow on day 0 in all non-NO-s subjects, but none in all NO subjects. In the NO-s group, LPA flow was confirmed in 87% (13/15) on day 2 and in 100% on day 5, however, there was no LPA flow from day 0 to day 5 in any of the NO-d group.
Our data indicate that PA diameters on day 0 and LPA flow are strongly prognostic in left-sided CDH and L/R ratio would appear to be a simple highly reliable indicator of the necessity for NO therapy.
确定肺动脉大小和血流在先天性膈疝（CDH）中是否具有预后价值。
连续28例接受高频振荡通气（HFOV）+一氧化氮（NO）标准方案治疗的左侧CDH患者，在出生后第0、2和5天通过超声心动图（EC）检查右、左肺动脉（RPA、LPA）直径、LPA/RPA直径（L/R）比值以及肺动脉血流，并进行前瞻性比较。
22例患者（78.6%）存活。其中，15例需要NO（NO-s组），7例不需要（非NO-s组）。所有6例死亡患者均需要NO（NO-d组）。在出生后第0天，NO-d组的RPA明显小于NO-s组或非NO-s组（分别为2.90±0.41 vs. 3.40±0.49或4.01±0.43；P<0.01）。在出生后第0天，NO-d组的LPA明显小于非NO-s组（2.13±0.45 vs. 3.39±0.34；P<0.01）。在出生后第0天，NO组患者的L/R比值明显小于非NO-s组患者（NO-s组为0.74±0.11；NO-d组为0.73±0.11）（0.84±0.03）（P<0.01）。在所有三组中，从出生后第0天到第5天，肺动脉直径和L/R比值均无明显变化。在所有非NO-s组患者出生后第0天均有LPA血流，但所有NO组患者均无。在NO-s组中，第2天87%（13/15）的患者确认有LPA血流，第5天100%的患者确认有LPA血流，然而，在任何NO-d组患者中，从出生后第0天到第5天均无LPA血流。
我们的数据表明，出生后第0天的肺动脉直径和LPA血流对左侧CDH具有很强的预后价值，L/R比值似乎是NO治疗必要性的一个简单且高度可靠的指标。
