Intensive Care, Erasmus MC-Sophia, Rotterdam, The Netherlands.
Semin Fetal Neonatal Med. 2011 Jun;16(3):139-44. doi: 10.1016/j.siny.2011.03.002. Epub 2011 Apr 3.
The primary therapeutic target for congenital diaphragmatic hernia (CDH) patients has shifted from emergency surgical repair towards a non-operative emergency of the newborn treated by interdisciplinary teams. The increased understanding of the epidemiological and pathophysiological aspects of CDH have led to an improved knowledge and application of prenatal diagnosis, postnatal ventilation strategies, treatment of associated pulmonary hypertension and the role of extracorporeal membrane oxygenation therapy. In the surgical field, the perspectives have changed with delayed CDH repair, the introduction of minimally invasive surgery and use of prosthetic material for closure of large defects. With decreased mortality, long term multi-organ morbidity has increased in some survivors. In the near future, randomized controlled trials on different aspects of therapy will determine evidence-based optimal care.
先天性膈疝 (CDH) 患者的主要治疗目标已经从紧急手术修复转向由多学科团队治疗的新生儿非手术急救。对 CDH 的流行病学和病理生理学方面的认识不断提高，导致对产前诊断、新生儿通气策略、相关肺动脉高压的治疗以及体外膜氧合治疗的作用有了更好的了解和应用。在手术领域，随着 CDH 修复的延迟、微创技术的引入以及用于闭合大缺损的假体材料的使用，观点也发生了变化。随着死亡率的降低，一些幸存者的长期多器官发病率增加。在不久的将来，关于治疗不同方面的随机对照试验将确定基于证据的最佳护理。
