先天性膈疝患儿术前肺功能和肺容积评估的预后

Prognosis with preoperative pulmonary function and lung volume assessment in infants with congenital diaphragmatic hernia.

作者信息

Antunes M J, Greenspan J S, Cullen J A, Holt W J, Baumgart S, Spitzer A R

机构信息

Department of Pediatrics, Thomas Jefferson University Jefferson Medical College, Philadelphia, PA 19107, USA.

出版信息

Pediatrics. 1995 Dec;96(6):1117-22.

PMID:7491232

Abstract

OBJECTIVES

To determine whether fatal pulmonary hypoplasia, as assessed by functional residual capacity (FRC), can be distinguished from other reversible causes of respiratory failure in infants with congenital diaphragmatic hernia (CDH).

METHODS

In the present study, 25 term neonates having CDH without other anomalies (mean birth weight +/- SD, 3.25 +/- 0.50 kg) were enrolled prospectively into a protocol evaluating pulmonary function. Lung compliance (CL) and FRC were measured before diaphragmatic repair and compared with the highest oxygenation index (OI) and lowest PaCO2, also obtained preoperatively. Pulmonary function assessment was repeated after diaphragm repair on postoperative days 3 and 7. CL was determined by esophageal manometry and pneumotachography, and FRC was determined by helium dilution.

RESULTS

Fifteen infants (60%) survived to hospital discharge. Eighteen (72%) required extracorporeal membrane oxygenation (ECMO) for support, and of these, 8 (44%) survived. PaCO2 was similar preoperatively in infants grouped as survivors without ECMO, survivors with ECMO, and nonsurvivors. In nonsurvivors (all of whom received ECMO), the preoperative OI was significantly higher (51 +/- 21), CL was less (0.11 +/- 0.04 mL/cm of water per kg), and FRC was smaller (4.5 +/- 1.0 mL/kg) than in the survivors who required ECMO (26 +/- 18, 0.18 +/- 0.08 mL/cm of water per kg, and 12 +/- 5 mL/kg, respectively), as well as in the survivors without ECMO, (6 +/- 2, 0.32 +/- 0.16 mL/cm of water per kg, and 15.8 +/- 4 mL/kg, respectively). The group surviving with ECMO had a higher OI than the infants surviving without ECMO. All nonsurviving infants had FRCs of less than 9.0 mL/kg preoperatively. In contrast, only 2 of the 15 survivors had preoperative FRCs less than 9 mL/kg.

CONCLUSIONS

The results of this study suggest that preoperative assessment of FRC may predict fatal pulmonary hypoplasia in most infants with CDH.

摘要

目的

确定通过功能残气量（FRC）评估的致命性肺发育不全能否与先天性膈疝（CDH）患儿其他可逆性呼吸衰竭病因相区分。

方法

在本研究中，25例足月新生儿患有CDH且无其他异常（平均出生体重±标准差，3.25±0.50kg），被前瞻性纳入一项评估肺功能的方案。在膈修补术前测量肺顺应性（CL）和FRC，并与术前获得的最高氧合指数（OI）和最低动脉血二氧化碳分压（PaCO2）进行比较。在术后第3天和第7天膈修补术后重复进行肺功能评估。CL通过食管测压法和呼吸流速描记法测定，FRC通过氦稀释法测定。

结果

15例婴儿（60%）存活至出院。18例（72%）需要体外膜肺氧合（ECMO）支持，其中8例（44%）存活。术前，未接受ECMO的存活婴儿、接受ECMO的存活婴儿和非存活婴儿的PaCO2相似。在非存活婴儿（均接受了ECMO）中，术前OI显著更高（51±21），CL更低（0.11±0.04ml/cm水柱每千克），FRC更小（4.5±1.0ml/kg），而接受ECMO的存活婴儿分别为（26±18、0.18±0.08ml/cm水柱每千克和12±5ml/kg），未接受ECMO的存活婴儿分别为（6±2、0.32±0.16ml/cm水柱每千克和15.8±4ml/kg）。接受ECMO存活的婴儿组OI高于未接受ECMO存活的婴儿。所有非存活婴儿术前FRC均小于9.0ml/kg。相比之下，15例存活婴儿中只有2例术前FRC小于9ml/kg。