Steimle C N, Meric F, Hirschl R B, Bozynski M, Coran A G, Bartlett R H
Department of Surgery, University of Michigan Medical Center, Ann Arbor.
J Pediatr Surg. 1994 Aug;29(8):997-1001. doi: 10.1016/0022-3468(94)90266-6.
Extracorporeal life support (ECLS) has been used for neonates with congenital diaphragmatic hernia (CDH) and respiratory failure at the authors' hospital since June 1981. In 1988, criteria for inclusion in ECLS were broadened to include "nonhoneymoon" infants (honeymoon: best postductal PaO2 of > 50 mm Hg). To evaluate the impact of this approach on the treatment of CDH, the authors reviewed the records of all newborns managed at their institution, since the availability of ECLS in 1981, who were symptomatic with CDH in the first 24 hours of life (n = 111). The patients were divided chronologically into two groups: 1981 to 1987 (early ECLS, n = 36) and 1988 to 1993 (expanded ECLS, n = 75). The data demonstrate that the number of CDH patients managed at our institution each year has increased (1981 to 1987 = 6, 1988 to 1993 = 14) as has the severity of associated respiratory insufficiency (% of patients with best PaO2 of < or = 50 mm Hg: 1981 to 1987 = 6%, 1988 to 1993 = 28%). Overall, the survival rate was lower for patients in the expanded ECLS group (59% v 75%; P = .121). When the survival rates for patients supported with ECLS postoperatively were compared for the expanded and early groups, a significant difference (59% v 80%; P < .05) was noted.(ABSTRACT TRUNCATED AT 250 WORDS)
自1981年6月起，作者所在医院就已将体外生命支持（ECLS）用于患有先天性膈疝（CDH）及呼吸衰竭的新生儿。1988年，ECLS的纳入标准放宽至包括“非蜜月期”婴儿（蜜月期：导管后最佳动脉血氧分压>50 mmHg）。为评估该方法对CDH治疗的影响，作者回顾了自1981年有ECLS以来，在其机构接受治疗的所有出生后24小时内出现CDH症状的新生儿记录（n = 111）。这些患者按时间顺序分为两组：1981年至1987年（早期ECLS组，n = 36）和1988年至1993年（扩大ECLS组，n = 75）。数据表明，我院每年治疗的CDH患者数量有所增加（1981年至1987年 = 6例，1988年至1993年 = 14例），同时相关呼吸功能不全的严重程度也有所增加（最佳动脉血氧分压≤50 mmHg的患者百分比：1981年至1987年 = 6%，1988年至1993年 = 28%）。总体而言，扩大ECLS组患者的生存率较低（59%对75%；P = 0.121）。当比较扩大组和早期组术后接受ECLS支持患者的生存率时，发现有显著差异（59%对80%；P < 0.05）。（摘要截选至250字）
