Abel M, Blum C, Pringsheim W, Ortlieb H, Waldmann D
Anasth Intensivther Notfallmed. 1986 Oct;21(5):280-3.
The authors report on 36 premature and term infants with congenital defects of the diaphragm, including 17 patients who developed a severe respiratory insufficiency either immediately after birth or during the first 30 minutes of life. The overall mortality rate was 64%; the results of treatment were marked by a particularly high mortality rate among the patients with early respiratory insufficiency: out of 17 patients, 12 died. The evaluation of the courses confirmed that adequate preoperative primary care is of major prognostic importance in patients with early respiratory insufficiency. On the basis of personal experience the authors have formulated the following recommendations for improving diagnosis and therapy at this stage of care: greater use of sonography examination methods for antepartal diagnosis of congenital defects of the diaphragm, making it possible to treat the corresponding high-risk pregnancies at an early stage in clinics equipped for neonatologic and pediatric surgical treatment; early intubation respiration with a ventilation technique which does not overstrain the patient, in newborns with abnormal respiration and suspected congenital defects of the diaphragm; the great diagnostic importance of plain radiographs of the thorax and abdomen; neonatologic and intensive medical stabilization treatment in patients with severely suppressed metabolism prior to the anesthesiologic and surgical stress of closure of the diaphragm defect.
作者报告了36例患有先天性膈缺陷的早产和足月婴儿，其中17例在出生后即刻或出生后30分钟内出现严重呼吸功能不全。总体死亡率为64%；治疗结果显示，早期呼吸功能不全患者的死亡率特别高：17例患者中有12例死亡。病程评估证实，对于早期呼吸功能不全的患者，充分的术前初级护理具有重要的预后意义。基于个人经验，作者制定了以下在这一护理阶段改善诊断和治疗的建议：更多地使用超声检查方法进行产前诊断先天性膈缺陷，以便能够在配备新生儿和小儿外科治疗设备的诊所对相应的高危妊娠进行早期治疗；对于呼吸异常且怀疑有先天性膈缺陷的新生儿，采用不过度加重患者负担的通气技术进行早期插管呼吸；胸部和腹部X线平片具有重要的诊断意义；对于在膈缺陷闭合的麻醉和手术应激之前代谢严重受抑制的患者，进行新生儿和重症医学稳定治疗。
