新生儿先天性膈疝死亡危险因素分析

目的 探讨导致先天性膈疝（congenital diaphragmatic hernia,CDH）死亡的危险因素.方法 回顾性分析近10年来诊断明确的37例CDH患儿,分析其临床特点和危险因素,利用非条件多元回归进行死亡危险因素分析.结果 37例患儿中有29例进行了手术,其中CDH总病死率为32.4％（12/37）,手术病死率为13.8％ （4/29）.存活组（25例）与死亡组（12例）间,在出生体重[（3.12±0.41）kg vs （2.66±0.65） kg]、住院年龄[（135.14 ±209.71）h vs （6.67 ±7.79）h]、住院时间[（16.52±6.23）d vs （1.25 ±1.38）d]、氧合指数[（239.55±115.95） mmHg vs （96.10±59.18） mmHg,1 mmHg=0.133 kPa]、早期产前诊断（3例vs 6例）、右侧膈疝（1例vs 4例）、心脏畸形（2例vs 6例）和持续性肺动脉高压（3例vs 7例）等差异有统计学意义（P＜0.05）.通过多元回归分析,CDH的死亡危险因素分别为产前诊断（OR=20.97,95％ CI 1.60～ 275.78）,低氧合指数（OR=18.12,95％ CI 0.80 ～ 123.12）和心脏畸形（OR=22.0,95％CI 1.46～332.32）.结论 CDH有较高的病死率,死亡危险因素为产前诊断、低氧合指数和心脏畸形.

Risk factors associated with death of newborn with congenital diaphragmatic hernia

Objective To investigate the risk factors of congenital diaphragmatic hernia （CDH） deaths.Methods A retrospective study was conducted on 37 CDH patients during 10 years.Clinical characteristics and risk factors were compared and non-conditional logistic regression analysis was performed to determine independent predictors for mortality.Results Twenty nine patients,from a total of 37,underwent surgery for CDH.The total mortality rate in patients with CDH was 32.4％ （12/37） and the overall operative mortality was 13.8％ （4/29）.There was a significant difference between CDH patients who survived （n =25） and those who died （n =12） in birth weight[（3.12±0.41） kg vs （2.66 ±0.65） kg],the age on admission [（135.14 ± 209.71） h vs （6.67 ± 7.79） h],hospital length of stay [（16.52 ± 6.23） d vs （1.25 ±1.38） d],oxygenation index[（239.55 ± 115.95） mmHg vs （96.10 ±59.18） mmHg,1 mmHg =0.133 kPa],early antenatal diagnosis （3 cases vs 6 cases）,right congenital diaphragmatic hernia（1 cases vs 4 cases）,cardiac malformations （2 cases vs 6 cases） and presence of persistent pulmonary hypertension of newborn （3 cases vs 7 cases） （P ＜0.05）.Using logistic regression analysis,the following factors independently predicted mortality were antenatal diagnosis （OR =20.97,95％ CI 1.60 ～ 275.78）,low oxygenation index （OR =18.12,95 ％ CI 0.80 ～ 123.12） and cardiac malformations （OR =22.0,95 ％ CI 1.46 ～ 332.32）.Conclusion CDH patients have higher mortality.Risk factors for mortality in neonatal CDH are associated with early antenatal diagnosis,low oxygenation index and cardiac malformations.