Tyson K R, Schwartz M Z, Marr C C
J Pediatr Surg. 1985 Aug;20(4):415-7. doi: 10.1016/s0022-3468(85)80231-1.
Respiratory failure from pulmonary hypoplasia continues to be the major cause of death in newborn infants with diaphragmatic hernia. Recent investigations have suggested that postnatally induced pulmonary injury can result from excessive positive or negative intrathoracic pressure and contribute to the respiratory deterioration. Therefore, the method of thoracic drainage on the side of the diaphragmatic hernia is critical in controlling and maintaining normal intrathoracic pressure in both intrathoracic spaces. No chest tube or an ipsilateral chest tube connected to water seal, can result in either excessive negative or positive intrathoracic pressure and, therefore, both methods should be avoided. Recently, we employed a "balanced" intrathoracic drainage system which maintains the ipsilateral intrathoracic pressure within the normal physiologic range of +2 to -8 cm H2O regardless of the degree of pulmonary hypoplasia, presence of an ipsilateral pulmonary air leak, straining by the infant, or mechanical ventilation. This system is simple, requires no suction apparatus, and is easily assembled with equipment readily available within the hospital. This technique has been utilized in 18 newborn infants with diaphragmatic hernia and pulmonary hypoplasia. There have been no complications which specifically could be related to the balanced drainage system.
肺发育不全所致呼吸衰竭仍是先天性膈疝新生儿的主要死因。近期研究表明，出生后胸腔内压力过高或过低均可导致肺损伤，进而促使呼吸功能恶化。因此，膈疝侧的胸腔引流方法对于控制并维持双侧胸腔内正常压力至关重要。不放置胸管或在同侧胸管连接水封瓶，均可导致胸腔内压力过高或过低，故应避免这两种方法。最近，我们采用了一种“平衡”胸腔引流系统，该系统可将同侧胸腔内压力维持在+2至-8 cm H2O的正常生理范围内，而不受肺发育不全程度、同侧肺漏气情况、患儿用力或机械通气的影响。该系统操作简单，无需负压吸引装置，且易于使用医院现有设备组装。本技术已应用于18例患有先天性膈疝和肺发育不全的新生儿。尚未出现任何明确与平衡引流系统相关的并发症。
