- 期刊
Prediction of Outcome in Infants with Congenital Diaphragmatic Hernia or Severe Diaphragmatic Eventration
預測先天性橫膈膜疝氣或嚴重橫性膈膜膨出病人之預後
摘要
先天性橫膈膜疝氣及嚴重性橫膈膜膨出仍然有高死亡率，本篇研究的目的在於辨認先天性橫膈膜疝氣及嚴重橫肉性膈膜的預後因子，並且測定是否近肺動脈的大小或截面積與臨床預後有關。 我們回溯性的分析12年中26位病童的病歷20位先天性橫膈膜疝氣，及6位，且無合併其它明顯異常。我們比較存活病人與死亡病人的産前記錄，手術前的臨床症狀。血液氣體檢查及心臓超音波檢查。 10位病人（8位先天性橫膈膜，2位嚴重橫性膈膜）在出生後2至16天間死亡，包括2位病人因爲嚴重低血氧而未接受手術，存活者在統計上有較高的1分鍾及5分鍾的Apgar分數，較高的手術前最差的血液動脈PH值，較低的氧氣指數，較低的血液二氧化碳濃度（P值小於0.05）。雖然心臓超音波測量的McGoon指數在存活者較高，但並無統計上的意義。而Nakada肺動脈指數則在統計上有明顯意義。 結論是Apgar指數，血液二氧化碳濃度，氧氣指數，PH值能預測先天性橫膈膜疝氣及嚴重橫膈膜病人之預後。Nakada指數是預測先天性橫膈膜疝氣或嚴重性橫膈膜膨出病人臨床預後有用的指標。
並列摘要
Congenital diaphragmatic hernia (CDH) and severe congenital diaphragmatic eventration (SDE) still have high mortality. Our aims were to identify clinical prognostic factors for CDH and SDE, and to determine whether the size or area of the proximal bilateral pulmonary arteries (PA) correlate with the clinical outcome. We retrospectively analyzed medical charts of 26 patients-20 with CDH and 6 with SDE, but no obvious other associated anomalies-admitted over a 12-year period. We compared prenatal history, clinical manifestations, blood gas, and echocardiography before surgery in the survivors and the non-survivors. Ten patients (8 CDH, 2 SDE) died 2 to 16 days after birth, including 2 patients without surgery due to progressive hypoxemia. The survivors had significantly higher 1-and 5-min Apgar scores, higher the worst preductal arterial blood gas pH levels, lower oxygen indices, and lower PaCO2 (P＜0.05). The McGoon index of PA size measured by echocardiography was higher in survivors, but not statistically significant Nakada PA index results, however, were statistically significant (93.07±32.02 vs. 121.07±27.08, P＜0.05) In conclusion, Apgar scores, preductal PaCO2, oxygen index, and pH level can predict prognosis in infants with CDH and SDE. The Nakada PA index, however, might be a useful prognostic marker for patients with CDH and SDE.
延伸閱讀
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