出生后24小时内依据相关因素对先天性膈疝进行风险分层。
Risk stratification for congenital diaphragmatic hernia by factors within 24 h after birth.
作者信息
Terui K, Nagata K, Kanamori Y, Takahashi S, Hayakawa M, Okuyama H, Inamura N, Yoshida H, Taguchi T, Usui N
机构信息
Department of Pediatric Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Department of Pediatric Surgery, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
出版信息
J Perinatol. 2017 Jul;37(7):805-808. doi: 10.1038/jp.2017.11. Epub 2017 Feb 23.
OBJECTIVE
To establish a simple risk stratification system for patients with congenital diaphragmatic hernia (CDH) based on postnatal information within 24 h after birth.
STUDY DESIGN
A multi-institutional retrospective cohort study was conducted including 348 neonates who had isolated CDH born between 2006 and 2010. Based on the two most powerful variables for 90-day survival selected by multivariate analyses, a risk stratification system was established.
RESULTS
Multiple logistic regression analysis identified two adverse prognostic factors: an Apgar score at 1 min (Ap1) of 0-4 (odds ratio (OR) 3.3, P=0.004), and a best oxygenation index (OI) ⩾8.0 (OR 11.4, P<0.001). Based on a combinations of these two factors, patients were classified into three risk categories. The 90-day survival rates in categories 1-3 were 100, 88 and 52%, respectively (P<0.001).
CONCLUSION
Our simple risk stratification system based on Ap1 and best OI was capable of predicting mortality well.
目的
基于出生后24小时内的产后信息，为先天性膈疝（CDH）患者建立一个简单的风险分层系统。
研究设计
开展了一项多机构回顾性队列研究，纳入了2006年至2010年间出生的348例单纯性CDH新生儿。基于多变量分析选出的对90天生存率影响最大的两个变量，建立了一个风险分层系统。
结果
多因素logistic回归分析确定了两个不良预后因素：1分钟时的阿氏评分（Ap1）为0 - 4分（比值比（OR）3.3，P = 0.004），以及最佳氧合指数（OI）≥8.0（OR 11.4，P < 0.001）。根据这两个因素的组合，将患者分为三个风险类别。1 - 3类别的90天生存率分别为100%、88%和52%（P < 0.001）。
结论
我们基于Ap1和最佳OI的简单风险分层系统能够很好地预测死亡率。
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