近年来先天性膈疝患儿生存率的提高：体外膜肺氧合可用性及相关因素的影响
Improvement of survival in infants with congenital diaphragmatic hernia in recent years: effect of ECMO availability and associated factors.
作者信息
Kattan Javier, Godoy Loreto, Zavala Alejandro, Faunes Miriam, Becker Pedro, Estay Alberto, Fabres Jorge, Toso Paulina, Urzúa Soledad, Becker Jorge, Cerda Jaime, González Alvaro
机构信息
Department of Pediatrics, School of Medicine, Pontificia Universidad Católica de Chile, Lira 85, Piso 5, Santiago, Chile.
出版信息
Pediatr Surg Int. 2010 Jul;26(7):671-6. doi: 10.1007/s00383-010-2624-3. Epub 2010 May 29.
BACKGROUND/PURPOSE: Survival of patients with congenital diaphragmatic hernia (CDH) depends both on non-modifiable congenital conditions and on modifiable pre and postnatal management. ECMO improves survival up to 80% in neonates with CDH in the best ECMO centers worldwide. The first Neonatal ECMO Program in Chile was started in our University in 2003. Our objective is to determine the impact of a Neonatal ECMO Program in a level III NICU on newborns with CDH.
METHODS
Data of all newborns with CDH admitted to our NICU was separated into two groups: pre ECMO (1996-2003) and ECMO (2003-2007). Crude and adjusted odds ratios for 24 months survival were estimated by logistic regression.
RESULTS
Data of 46 newborns with CDH was analysed, 20 in the pre ECMO and 26 in the ECMO period. Patient characteristics were similar in both groups; however, 24-month survival increased significantly from 25% (5/20) in the pre ECMO period to 77% (20/26) in the ECMO period (P = 0.001). Adjusted odds ratios for 24-month survival were 26.98 for OI <or= 40, 7.58 for 5 min Apgar >or= 7 and 17.5 for ECMO availability.
CONCLUSIONS
The establishment of an ECMO program was associated with a significant increase in long-term survival for infants with CDH.
背景/目的：先天性膈疝（CDH）患儿的存活既取决于不可改变的先天性状况，也取决于可改变的产前和产后管理。在全球最佳的体外膜肺氧合（ECMO）中心，ECMO可将CDH新生儿的存活率提高至80%。智利首个新生儿ECMO项目于2003年在我校启动。我们的目的是确定三级新生儿重症监护病房（NICU）中的新生儿ECMO项目对CDH新生儿的影响。
方法
将入住我们NICU的所有CDH新生儿的数据分为两组：ECMO前（1996 - 2003年）和ECMO（2003 - 2007年）。通过逻辑回归估计24个月生存率的粗比值比和调整比值比。
结果
分析了46例CDH新生儿的数据，ECMO前组20例，ECMO期间组26例。两组患者特征相似；然而，24个月生存率从ECMO前时期的25%（5/20）显著提高到ECMO期间的77%（20/26）（P = 0.001）。对于24个月生存率，氧合指数（OI）≤40时调整后的比值比为26.98，5分钟阿氏评分≥7时为7.58，有ECMO可用时为17.5。
结论
ECMO项目的建立与CDH婴儿长期存活率的显著提高相关。
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