Puffinbarger N K, Taylor D V, Tuggle D W, Tunell W P
Department of Surgery, University of Oklahoma College of Medicine, Oklahoma City, USA.
J Pediatr Surg. 1996 Feb;31(2):280-2. doi: 10.1016/s0022-3468(96)90016-0.
Previous criteria for primary reduction of the herniated viscera in newborn infants with gastroschisis included intraoperative respiratory rate, cardiac indices, degree of viscero-abdominal disproportion, size of defect, and lower extremity turgor. From 1976 through 1993, 129 neonates with gastroschisis were treated at Children's Hospital of Oklahoma. Intraoperative end-tidal carbon dioxide (ETCO2) monitoring was standard therapy beginning in 1985. The authors evaluated the effect of abdominal closure on ETCO2 to determine if there was a particular ETCO2 level at which closure was not feasible. There was no difference in overall mortality, birth weight, or postoperative ventilation requirements between children who had closure before 1985 (ie, without ETCO2 monitoring) and those who had repair after 1985. However, more cases in the 1985-1993 group had primary closure, and none of these required conversion to a staged procedure. An ETCO2 of > or = 50 suggests that primary closure may be unsafe. These data suggest that infants with gastroschisis can have primary closure based on intraoperative ETCO2 monitoring; no additional invasive monitoring would be necessary to assess closure.
先前关于腹裂新生儿突出脏器一期还纳的标准包括术中呼吸频率、心脏指数、内脏与腹部比例失调程度、缺损大小以及下肢充盈情况。1976年至1993年期间，俄克拉何马州儿童医院收治了129例腹裂新生儿。自1985年起，术中监测呼气末二氧化碳（ETCO2）成为标准治疗手段。作者评估了腹壁关闭对ETCO2的影响，以确定是否存在某个特定的ETCO2水平，在该水平下关闭腹壁不可行。1985年之前（即未进行ETCO2监测）接受腹壁关闭手术的患儿与1985年之后接受修复手术的患儿在总体死亡率、出生体重或术后通气需求方面并无差异。然而，1985 - 1993年组中有更多病例进行了一期关闭，且这些病例均无需转为分期手术。ETCO2≥50提示一期关闭可能不安全。这些数据表明，腹裂婴儿可基于术中ETCO2监测进行一期关闭；无需额外的有创监测来评估关闭情况。
