Ramenofsky M L
J Pediatr Surg. 1979 Dec;14(6):750-6. doi: 10.1016/s0022-3468(79)80259-6.
Newborns with congenital diaphragmatic hernia generally survive operative repair of the hernia but develop progressive respiratory insufficiency that proves fatal. One cause for the progressive respiratory insufficiency may be the overexpansion of the contralateral lung. It is postulated that the overexpansion occurs due to the empty space created by the lack of expansion of the hypoplastic lung on the side of the hernia. To test this theory, an animal experiment was devised to mimic the postoperative state in patients with diaphragmatic hernia. It was concluded that (1) A decrease in intrapleural pressure below normal in an empty hemithorax causes the opposite lung to overexpand into the empty hemithorax in neonatal Beagle puppies. (2) The overexpansion resulted in progressive respiratory insufficiency. (3) Increasing the intrapleural pressure by insufflation of air into the empty hemithorax stopped the overexpansion of the contralateral lung. (4) By not allowing the contralateral lung to overexpand, progressive respiratory insufficiency was prevented. (5) This may be a useful technique in neonates with congenital diaphragmatic hernia.
患有先天性膈疝的新生儿一般能在疝修补手术后存活，但会出现进行性呼吸功能不全，最终导致死亡。进行性呼吸功能不全的一个原因可能是对侧肺过度扩张。据推测，这种过度扩张是由于疝侧发育不全的肺缺乏扩张而形成的空隙导致的。为了验证这一理论，设计了一项动物实验来模拟膈疝患者的术后状态。得出的结论是：（1）在新生比格幼犬中，空侧半胸内胸膜腔内压低于正常会导致对侧肺向空侧半胸过度扩张。（2）这种过度扩张导致进行性呼吸功能不全。（3）向空侧半胸内注入空气以增加胸膜腔内压可阻止对侧肺的过度扩张。（4）通过不让对侧肺过度扩张，可预防进行性呼吸功能不全。（5）这可能是治疗先天性膈疝新生儿的一种有用技术。
