58例新生儿先天性膈疝围术期监护

目的 总结该院6年先天性膈疝(CDH)的围术期监护经验.方法 收集该院2010年1月至2016年4月共58例新生儿CDH的临床病例资料进行回顾性分析,根据患儿诊断后是否进行手术治疗,分为治疗组(39例)和放弃组(19例);根据出生后6h内是否出现呼吸窘迫症状,将治疗组分为重症A组(29例)及非重症B组(10例).结果 手术距入院时间A组(38.07±18.78)h,B组(21.10±5.46)h,ICU监护时间中位数A组5(2.00,9.50)d、B组2(1.00,2.25)d,差异均有统计学意义(P＜0.05);术后机械通气时间中位数A组34(19.5,42.5)h、B组23(16.5,39.5)h,平均住院时间A组(16.76±5.99)d、B组(15.40±2.17)d,差异均无统计学意义(P＞0.05);放弃组19例,均于入院后3d内放弃治疗,院内死亡5例.治疗组39例无一例死亡.结论 CDH是新生儿危重症之一,加强围术期监护是提高CDH生存率的关键.

Perioperative intensive care of neonatal congenital diaphragmatic hernia in 58 cases

Objective To summarize the experiences of perioperative intensive care of neonatal congenital diaphragmatic hernia(CDH) in our hospital during six years.Methods The clinical data of 58 CDH cases in our hospital from January 2010 to April 2016 were collected and retrospectively analyzed.All patients were divided into the treatment group(n=39) and giving up group (n=19) according to whether conducting surgery.The treatment group was divided into the severe group(A) and non-severe group (B) according to whether suffering from respiratory distress within 6 h after born.Results The time from operation to admission was (38.07±18.78) h in the group A and (21.10±5.46) h in the group B,the median of ICU monitoring time was 5(2.00,9.50) d in the group A and 2(1.00,2.25)d in the group B(P＜0.05).The median of postoperative mechanical ventilation time was 34 (19.5,42.5) h in the group A and 23(16.5,39.5)h in the group B,the average hospitalization time was (16.76±5.99)d in the group A and (15.40± 2.17) d in the group B,the difference was not statitically significant (P＞0.05);19 cases (giving up group) had no operation and gave up the operative treatment within 3 d after admission,and 5 cases died in hospital.39 cases in the treatment group were operated without death case.Conclusion CDH is one of neonatal critical diseases.Strengthening the perioperative intensive care is the key to improve the survival rates of CDH.