中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2014年
9期
590-593
,共4页
祝菁%杨祖菁%王磊%王蓓
祝菁%楊祖菁%王磊%王蓓
축정%양조정%왕뢰%왕배
疝,横膈%超声检查,产前%预后
疝,橫膈%超聲檢查,產前%預後
산,횡격%초성검사,산전%예후
Hernia,diaphragmatic%Ultrasonography,prenatal%Prognosis
目的 探讨先天性膈疝胎儿的产前诊断特点及影响胎儿预后的相关因素. 方法 回顾性分析2006年1月1日至201 3年3月31日存上海交通大学医学院附属新华医院产前诊断中心诊断的57例先天性膈疝胎儿的病历资料,结合超声检查特点和新生儿存活情况,分析先天性膈疝胎儿预后不良的危险因素.采用t检验、x2检验及Logistic回归进行统计学分析. 结果 57例膈疝胎儿中左侧膈疝45例(79％),右侧膈疝12例(21％).57例膈疝胎儿中,引产终止妊娠14例;33例出生后手术治疗,术后存活23例,死亡10例,总体存活率为40％(23/57);另10例胎儿生后未行手术治疗,均死亡.存活新生儿出生体重明显高于死亡新生儿[(3 173±348)与(2 846±568)g,t=2.238,P=0.033],而引产组的诊断孕周明显早于存活组[(24.0±4.1)与(30.0±6.0)周,t=3.181,P=0.003].存活组肺头比(lung-to head ratio,LHR)≥1.4的比例为91％ (21/23).线性趋势检验显示,LHR值与膈疝胎儿的预后之间存在线性相关关系(x2=9.223,P=0.002),相关系数为-0.730(P=0.000).LHR＜1.4时新生儿死亡的危险是LHR≥1.4者的35.867倍(95％CI:1.861～691.341,P=0.018);羊水过多的新生儿死亡危险是无羊水过多者的9.285倍(95％CI:1.102～78.212,P=0.040).而右侧膈疝(OR=0.158,95％CI:0.009～2.824,P=0.210)、肝脏疝人胸腔(OR=1.730,95％CI:0.144～20.707,P=0.665)和新生儿出生体重(OR=1.002,95％CI:0.999～1.005,P=0.135)不是膈疝胎儿生后死亡的危险因素. 结论 先天性膈疝胎儿的存活率仍较低,胎儿膈疝出现的孕周、羊水量以及LHR与胎儿的预后不良密切相关.
目的 探討先天性膈疝胎兒的產前診斷特點及影響胎兒預後的相關因素. 方法 迴顧性分析2006年1月1日至201 3年3月31日存上海交通大學醫學院附屬新華醫院產前診斷中心診斷的57例先天性膈疝胎兒的病歷資料,結閤超聲檢查特點和新生兒存活情況,分析先天性膈疝胎兒預後不良的危險因素.採用t檢驗、x2檢驗及Logistic迴歸進行統計學分析. 結果 57例膈疝胎兒中左側膈疝45例(79％),右側膈疝12例(21％).57例膈疝胎兒中,引產終止妊娠14例;33例齣生後手術治療,術後存活23例,死亡10例,總體存活率為40％(23/57);另10例胎兒生後未行手術治療,均死亡.存活新生兒齣生體重明顯高于死亡新生兒[(3 173±348)與(2 846±568)g,t=2.238,P=0.033],而引產組的診斷孕週明顯早于存活組[(24.0±4.1)與(30.0±6.0)週,t=3.181,P=0.003].存活組肺頭比(lung-to head ratio,LHR)≥1.4的比例為91％ (21/23).線性趨勢檢驗顯示,LHR值與膈疝胎兒的預後之間存在線性相關關繫(x2=9.223,P=0.002),相關繫數為-0.730(P=0.000).LHR＜1.4時新生兒死亡的危險是LHR≥1.4者的35.867倍(95％CI:1.861～691.341,P=0.018);羊水過多的新生兒死亡危險是無羊水過多者的9.285倍(95％CI:1.102～78.212,P=0.040).而右側膈疝(OR=0.158,95％CI:0.009～2.824,P=0.210)、肝髒疝人胸腔(OR=1.730,95％CI:0.144～20.707,P=0.665)和新生兒齣生體重(OR=1.002,95％CI:0.999～1.005,P=0.135)不是膈疝胎兒生後死亡的危險因素. 結論 先天性膈疝胎兒的存活率仍較低,胎兒膈疝齣現的孕週、羊水量以及LHR與胎兒的預後不良密切相關.
목적 탐토선천성격산태인적산전진단특점급영향태인예후적상관인소. 방법 회고성분석2006년1월1일지201 3년3월31일존상해교통대학의학원부속신화의원산전진단중심진단적57례선천성격산태인적병력자료,결합초성검사특점화신생인존활정황,분석선천성격산태인예후불량적위험인소.채용t검험、x2검험급Logistic회귀진행통계학분석. 결과 57례격산태인중좌측격산45례(79％),우측격산12례(21％).57례격산태인중,인산종지임신14례;33례출생후수술치료,술후존활23례,사망10례,총체존활솔위40％(23/57);령10례태인생후미행수술치료,균사망.존활신생인출생체중명현고우사망신생인[(3 173±348)여(2 846±568)g,t=2.238,P=0.033],이인산조적진단잉주명현조우존활조[(24.0±4.1)여(30.0±6.0)주,t=3.181,P=0.003].존활조폐두비(lung-to head ratio,LHR)≥1.4적비례위91％ (21/23).선성추세검험현시,LHR치여격산태인적예후지간존재선성상관관계(x2=9.223,P=0.002),상관계수위-0.730(P=0.000).LHR＜1.4시신생인사망적위험시LHR≥1.4자적35.867배(95％CI:1.861～691.341,P=0.018);양수과다적신생인사망위험시무양수과다자적9.285배(95％CI:1.102～78.212,P=0.040).이우측격산(OR=0.158,95％CI:0.009～2.824,P=0.210)、간장산인흉강(OR=1.730,95％CI:0.144～20.707,P=0.665)화신생인출생체중(OR=1.002,95％CI:0.999～1.005,P=0.135)불시격산태인생후사망적위험인소. 결론 선천성격산태인적존활솔잉교저,태인격산출현적잉주、양수량이급LHR여태인적예후불량밀절상관.
Objective To explore the prenatal diagnosis and factors influencing prognosis of congenital diaphragmatic hernia (CDH).Methods Fifty seven cases of CDH prenatally diagnosed by ultrasound in the Department of Obstetrics,Xinhua Hospital from January 1,2006 to March 31,2013 were retrospectively reviewed.Prognosis and risk factors were analyzed by ultrasound characteristics and newborn status.Statistical analysis was performed using t test,x2 test and Logistic regression.Results Forty-five (79％)of all cases were left-side CDH and the rest 12 (21％)were right-side.Fourteen fetuses were aborted.Thirty three were delivered and treated surgically,twenty-three infants survived after surgery and ten died,with an overall survival rate of 40％ (23/57).The other ten cases were delivered,but died of no treated surgically.The birth weight of the surviving neonates was heavier than that of those who died [(3 173 ±348) vs (2 846±568)g,t=2.238,P=0.033].The gcstational age at diagnosis of the aborted fetuses was younger than that of the surviving neonates [(24.0 ± 4.1) vs (30.0± 6.0) weeks,t=3.181,P=0.003].Twenty-one (91％,21/23) of the surviving neonates had a lung-to-head ratio (LHR) ≥ 1.4.A linear trend test showed a negative correlation between LHR and adverse outcome (x2=9.223,P=0.002) with a correlation coefficient-0.730 (P=0.000).LHR＜1.4 (OR=35.867,95％CI:1.861-691.341,P=0.018) and polyhydramnios (OR=9.285,95％CI:1.102-78.212,P=0.040) were risk factors for neonatal death.Right-side CDH (OR=0.158,95％CI:0.009-2.824,P=0.210),liver herniation into the thorax (OR=1.730,95％CI:0.144 20.707,P=0.665) and birth weight (OR=l.002,95％CI:0.999-1.005,P=0.135) were not risk factors.Conclusions The survival rate of CDH is still low.Gestational age on diagnosis,presence of polyhydramnios and LHR＜ 1.4 predict an adverse outcome.
