摘要
目的 探讨超声对先天性膈疝(congenital diaphragmatic hernia,CDH)预后评估的应用价值.方法 回顾性分析2010年1月至2017年5月温州医科大学附属第二医院收治的CDH患儿68例,对初次确诊时间、膈疝侧别、肝脏位置、胃泡位置、有无并发畸形、L HR、O/E L HR等指标与病死率的关系进行分析,采用多因素logistic回归进行预后相关危险因素分析.结果 男31例,女37例,总病死率为39.7%(27/68).肝上型、产前确诊、并发畸形的患儿较肝下型、产后确诊、无并发畸形的患儿病死率分别高46.1% 、47.8% 、34.7%,差异有统计学意义(P<0.05).膈疝侧别及胃泡位置不同组之间病死率差别不大,差异无统计学意义(P>0.05).LHR≤1.4组病死率较LHR>1.4组高50%,O/E LHR≤45% 组病死率较O/E LHR>45% 组高45.6%,差异有统计学意义(P<0.05).LHR预测病死率的受试者工作特征曲线下面积为0.936(95%CI,0.837~1.000),O/E LHR预测病死率的曲线下面积为0.880(95%C I,0.745~1.000),两者差异无统计学意义(z=0.044,P=0.483).多因素logistic回归分析显示产前诊断、肝上型膈疝及并发畸形是患儿死亡的独立危险因素,OR值分别为10.534、8.843、11.234(P<0.05).结论 超声对临床评估CDH患儿的预后有重要的价值.
Objective To explore the value of ultrasonic scan for predicting mortality in children with congenital diaphragmatic hernia (CDH) .Methods Sixty-eight hospitalized CDH neonates were recruited and retrospectively analyzed from January 2010 to May 2017 .Ultrasonic markers including sidedness of hernia ,thoracic herniation of liver ,thoracic herniation of stomach ,diagnostic timing , presence of associated congenital anomalies ,lung-to-head ratio (L HR) and observed/expected lung-to-head ratio (O/E LHR) were analyzed .And logistic regression analysis was performed for determining the independent predictors for mortality .Results The overall mortality rate was 39 .7% (27/68 ) . Differences existed in mortality between children with an intrathoracic liver ,associated congenital anomalies and prenatally diagnosed as compared with those with an ectopic liver without anomalies and diagnosed postnatally (P< 0 .05) .And the mortality rate was 46 .1% ,47 .8% and 34 .7% higher respectively .Mortality was not significantly different between left-sided and right-sided hernias or between intrathoracic stomach and abdominal stomach ( P> 0 .05 ) .The mortality of patients with LHR≤1 .4 was 50% higher than that with LHR >1 .4 (P<0 .05) .Similarly the mortality of children with LHR ≤ 45% was 45 .6% higher than those with LHR > 45% (P<0 .05) .The area under the ROC curve for predicting mortality by LHR was 0 .936 (95% CI ,0 .837-1 .000) and O/E LHR 0 .880 (95% CI , 0 .745-1 .000 ) .The value of LHR and O/E LHR for predicting mortality was notsignificantly different (z=0 .044 , P=0 .483) .Logistic multivariate regression analysis indicated that prenatal diagnosis ,thoracic herniation of liver and associated congenital anomalies were independent predictors for mortality with odd ratios of 10 .534 ,8 .843 and 11 .234 respectively ( P< 0 .05 ) . Conclusions Ultrasound may become a useful tool of predicting the prognosis of CDH .
作者
周琳
叶万定
郑金珏
赵琦峰
陈鲜威
吴道珠
Zhou Lin;Ye Wanding;Zheng Jinjue;Zhao Qifeng;Chen Xianwei;Wu Daozhu(Department of Ultrasonography,Second Affiliated Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Pediatrics,Second Affiliated Hospital,Wenzhou Medical University,Wenzhou 325027,China;Children’s Department of Cardiovascular&Thoracic Surgery,Children’s Heart Center,Institute of Cardiovascular Development&Translational Medicine,Second Affiliated Hospital,Wenzhou Medical University,Wenzhou 325027,China;Department of Neonatology,Second Affiliated Hospital,Wenzhou Medical University,Wenzhou 325027,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2019年第11期998-1001,共4页
Chinese Journal of Pediatric Surgery
关键词
膈疝
先天性
超声检查
预后
Diaphragmatic hernia
congenital
Ultrasonography
Prognosis
