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先天性膈疝:单中心系列研究中的围产期预后因素及短期结局

Congenital Diaphragmatic Hernia: Perinatal Prognostic Factors and Short-Term Outcomes in a Single-Center Series.

作者信息

Pagliara Camilla, Zambaiti Elisa, Brooks Giulia, Bonadies Luca, Tognon Costanza, Salvadori Sabrina, Sgrò Alberto, Leon Francesco Fascetti

机构信息

Department of Pediatric Surgery, Universitary Hospital of Padova, 35128 Padova, Italy.

Department of Pediatric Surgery, Paediatric Hospital of Torino, 10126 Torino, Italy.

出版信息

Children (Basel). 2023 Feb 7;10(2):315. doi: 10.3390/children10020315.

DOI:10.3390/children10020315
PMID:36832444
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9955513/
Abstract

: Many prognostic factors for CDH patients are described and validated in the current literature: the size of diaphragmatic defects, need for patch repair, pulmonary hypertension and left ventricular dysfunction are recognized as the most influencing outcomes. The aim of this study is to analyze the influence of these parameters in the outcome of CDH patients in our department and identify any further prognostic factors. : An observational retrospective single-center study was conducted including all patients treated at our centre with posterolateral CDH between 01.01.1997 and 12.31.2019. The main outcomes evaluated were mortality and length of hospital stay. A univariate and multivariate analysis was performed. : We identified 140 patients with posterolateral CDH; 34.8% died before discharge. The overall median length of stay was 24 days. A univariate analysis confirmed that both outcomes are associated with the size of diaphragmatic defects, need for patch repair and presence of spleen-up ( < 0.05). A multivariate analysis identified that the need for patch repair and maximum dopamine dose used for cardiac dysfunction are independent parameters associated with the length of stay only ( < 0.001). : In our series, the duration of hospitalization is longer for newborns with CDH treated with higher doses of dopamine for left ventricular dysfunction or needing patch repair in large diaphragmatic defects.

摘要

目前的文献中描述并验证了许多先天性膈疝(CDH)患者的预后因素:膈缺损的大小、是否需要补片修补、肺动脉高压和左心室功能障碍被认为是对预后影响最大的因素。本研究的目的是分析这些参数对我院CDH患者预后的影响,并确定任何其他预后因素。

开展了一项观察性回顾性单中心研究,纳入了1997年1月1日至2019年12月31日期间在我院接受后外侧CDH治疗的所有患者。评估的主要结局为死亡率和住院时间。进行了单因素和多因素分析。

我们确定了140例后外侧CDH患者;34.8%在出院前死亡。总体中位住院时间为24天。单因素分析证实,这两个结局均与膈缺损的大小、是否需要补片修补以及脾脏上移有关(P<0.05)。多因素分析确定,是否需要补片修补以及用于治疗心功能不全的最大多巴胺剂量是仅与住院时间相关的独立参数(P<0.001)。

在我们的系列研究中,对于因左心室功能障碍而使用高剂量多巴胺治疗或因大的膈缺损需要补片修补的CDH新生儿,其住院时间更长。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/007c/9955513/a3c36a1f574d/children-10-00315-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/007c/9955513/a3c36a1f574d/children-10-00315-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/007c/9955513/a3c36a1f574d/children-10-00315-g001.jpg

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本文引用的文献

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Early Left Ventricular Dysfunction and Severe Pulmonary Hypertension Predict Adverse Outcomes in "Low-Risk" Congenital Diaphragmatic Hernia.早期左心室功能障碍和严重肺动脉高压预测“低危”先天性膈疝的不良结局。
Pediatr Crit Care Med. 2020 Jul;21(7):637-646. doi: 10.1097/PCC.0000000000002318.
2
When primary repair is not enough: a comparison of synthetic patch and muscle flap closure in congenital diaphragmatic hernia?当一期修复不足时:先天性膈疝中人工合成补片与肌瓣修补术的比较?
Pediatr Surg Int. 2020 Apr;36(4):485-491. doi: 10.1007/s00383-020-04634-y. Epub 2020 Mar 4.
3
Congenital diaphragmatic hernia-associated pulmonary hypertension.
先天性膈疝相关肺动脉高压。
Semin Perinatol. 2020 Feb;44(1):151167. doi: 10.1053/j.semperi.2019.07.006. Epub 2019 Jul 30.
4
Toward Standardized Management of Congenital Diaphragmatic Hernia: An Analysis of Practice Guidelines.朝向先天性横膈疝气之标准化管理:实务准则分析。
J Surg Res. 2019 Nov;243:229-235. doi: 10.1016/j.jss.2019.05.007. Epub 2019 Jun 18.
5
Congenital diaphragmatic hernia sacs: prenatal imaging and associated postnatal outcomes.先天性膈疝囊:产前影像学及相关产后结局
Pediatr Radiol. 2019 May;49(5):593-599. doi: 10.1007/s00247-018-04334-9. Epub 2019 Jan 11.
6
Congenital diaphragmatic hernia has a better prognosis when associated with a hernia sac.先天性膈疝合并疝囊时预后较好。
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7
Treating Hypotension in Preterm Neonates With Vasoactive Medications.使用血管活性药物治疗早产儿低血压
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