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先天性膈疝新生儿术后心肺衰竭的体外膜肺氧合成功应用：病例报告及文献综述

Successful extracorporeal membrane oxygenation for postoperative cardiopulmonary failure in newborns with congenital diaphragmatic hernia: case reports and literature reviews.

作者信息

Hong Song-Ming, Chen Xiu-Hua, Zhou Si-Jia, Hong Jun-Jie, Zheng Yi-Rong, Chen Qiang, Huang Jin-Xi

机构信息

Department of Cardiothoracic Surgery, Fujian Children's Hospital (Fujian Branch of Shanghai Children's Medical Center), College of Clinical Medicine for Obstetrics & Gynecology and Pediatrics, Fujian Medical University, Fuzhou, China.

出版信息

Front Pediatr. 2023 Jun 27;11:1158885. doi: 10.3389/fped.2023.1158885. eCollection 2023.

DOI:10.3389/fped.2023.1158885
PMID:37441572
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10333486/
Abstract

INTRODUCTION

Congenital diaphragmatic hernia (CDH) is a structural defect caused by inadequate fusion of the pleuroperitoneal membrane that forms the diaphragm, allowing peritoneal viscera to protrude into the pleural cavity. Up to 30% of newborns with CDH require extracorporeal membrane oxygenation (ECMO) support. As with all interventions, the risks and benefits of ECMO must be carefully considered in these patients. Cardiopulmonary function has been shown to worsen rather than improve after surgical CDH repair. Even after a detailed perioperative assessment, sudden cardiopulmonary failure after surgery is dangerous and requires timely and effective treatments.

METHOD

Three cases of cardiopulmonary failure after surgical CDH treatment in newborns have been reported. ECMO support was needed for these three patients and was successfully discontinued. We report our treatment experience.

CONCLUSION

ECMO is feasible for the treatment of postoperative cardiopulmonary failure in newborns with CDH.

摘要

引言

先天性膈疝（CDH）是一种由于构成膈肌的胸腹隔膜融合不全导致的结构缺陷，使得腹腔脏器突入胸腔。高达30%的先天性膈疝新生儿需要体外膜肺氧合（ECMO）支持。与所有干预措施一样，必须在这些患者中仔细权衡ECMO的风险和益处。已表明先天性膈疝手术修复后心肺功能会恶化而非改善。即使经过详细的围手术期评估，术后突然发生的心肺衰竭也很危险，需要及时有效的治疗。

方法

报告了3例新生儿先天性膈疝手术后发生心肺衰竭的病例。这3例患者均需要ECMO支持，且成功撤机。我们报告了我们的治疗经验。

结论

ECMO对于治疗先天性膈疝新生儿术后心肺衰竭是可行的。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/c631f3563b6d/fped-11-1158885-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/d73bb5951f9e/fped-11-1158885-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/e4c807547ba7/fped-11-1158885-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/c631f3563b6d/fped-11-1158885-g003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/d73bb5951f9e/fped-11-1158885-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/e4c807547ba7/fped-11-1158885-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/271e/10333486/c631f3563b6d/fped-11-1158885-g003.jpg

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本文引用的文献

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Prenatal predictors of mortality in fetuses with congenital diaphragmatic hernia: a systematic review and meta-analysis.先天性膈疝胎儿死亡的产前预测因素：系统评价和荟萃分析。
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Congenital diaphragmatic hernia.先天性膈疝。
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Arrhythmias Requiring ECMO in Infants Without Structural Congenital Heart Disease.无结构性先天性心脏病婴儿中需要体外膜肺氧合的心律失常
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Optimization of surgical timing of congenital diaphragmatic hernia using the quantified flow patterns of patent ductus arteriosus.利用动脉导管未闭的量化血流模式优化先天性膈疝的手术时机。
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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。
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Insufflation in minimally invasive surgery: Is there any advantage in staying low?微创外科中的注气：低位操作有优势吗？
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The role of ECMO in the management of congenital diaphragmatic hernia.ECMO 在先天性膈疝治疗中的作用。
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Extracorporeal Membrane Oxygenation in Congenital Diaphragmatic Hernia.先天性膈疝的体外膜肺氧合
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