CAJ | 학술논문

目的探讨先天性膈疝的产前诊断和生后治疗一体化管理模式的价值. 方法对广东省妇幼保健院2012年1月至2014年1月经产前超声和MRI诊断明确、并采取一体化管理模式的先天性膈疝病例25例进行回顾性分析.一体化管理模式包括产前管理(产前诊断和产前咨询)、围产期管理(产前检查和分娩)以及出生后治疗. 结果 25例胎儿中,重度5例,中度9例,轻度11例.1例重度胎儿在妊娠26周确诊后,因社会因素引产,其余24例选择继续妊娠,均在妊娠35周以后分娩.12例因社会因素剖宫产,1例因双胎行剖宫产,其余11例经阴道分娩.25例CDH患儿产前诊断的胎龄为妊娠(24.5±3.5)周,24例继续妊娠的患儿的出生胎龄为(37.5±1.4)周.13例中、重度胎儿均在妊娠32周常规应用地塞米松行促胎肺成熟治疗,7例实施断脐前气管插管,6例于断脐后插管.11例轻度患儿生后给予面罩吸氧.1 3例中、重度患儿生后常规给予高频振荡通气,平均通气时间58 h,并根据需要辅以吸入一氧化氮治疗,平均使用一氧化氮时间为52 h.除2例重度生后未手术即死亡外,其余22例于新生儿期行手术治疗.其中1例中度患儿于术后48 h发生肺动脉高压、呼吸功能衰竭死亡,1例重度患儿于生后2个月因经济原因放弃治疗.20例(90.9％)患儿存活至出院. 结论应用产前诊断和生后治疗一体化管理模式对胎儿膈疝进行有效管理,可使胎儿膈疝的诊断和治疗实现无缝衔接,有效降低医疗风险.
목적 탐토선천성격산적산전진단화생후치료일체화관리모식적개치. 방법 대광동성부유보건원2012년1월지2014년1월경산전초성화MRI진단명학、병채취일체화관리모식적선천성격산병례25례진행회고성분석.일체화관리모식포괄산전관리(산전진단화산전자순)、위산기관리(산전검사화분면)이급출생후치료. 결과 25례태인중,중도5례,중도9례,경도11례.1례중도태인재임신26주학진후,인사회인소인산,기여24례선택계속임신,균재임신35주이후분면.12례인사회인소부궁산,1례인쌍태행부궁산,기여11례경음도분면.25례CDH환인산전진단적태령위임신(24.5±3.5)주,24례계속임신적환인적출생태령위(37.5±1.4)주.13례중、중도태인균재임신32주상규응용지새미송행촉태폐성숙치료,7례실시단제전기관삽관,6례우단제후삽관.11례경도환인생후급여면조흡양.1 3례중、중도환인생후상규급여고빈진탕통기,평균통기시간58 h,병근거수요보이흡입일양화담치료,평균사용일양화담시간위52 h.제2례중도생후미수술즉사망외,기여22례우신생인기행수술치료.기중1례중도환인우술후48 h발생폐동맥고압、호흡공능쇠갈사망,1례중도환인우생후2개월인경제원인방기치료.20례(90.9％)환인존활지출원. 결론 응용산전진단화생후치료일체화관리모식대태인격산진행유효관리,가사태인격산적진단화치료실현무봉함접,유효강저의료풍험.
Objective To share our experiences on integrated services in providing fetal diagnosis and postnatal treatment for congenital diaphragmatic hernia(CDH).Methods A retrospective analysis was conducted on 25 pregnancies diagnosed as CDH by both prenatal ultrasound and MRI in Maternal and Children Hospital of Guangdong Province from January 2012 to January 2014.All of the subjects received integral medical management including prenatal management (prenatal diagnosis and consultation), perinatal management (prenatal care and delivery) and neonatal treatment.Results Among the 25 CDH fetuses, 11 were mild, nine were moderate, and five were severe.One severe case, who was diagnosed at 26 gestational weeks, was aborted on demand of the mother.The other 24 cases continued their pregnancy and all delivered after 35 weeks including 13 cesarean sections (one due to twin pregnancy and 12 due to maternal demand) and 11 vaginal birth.The mean gestational age when CDH was diagnosed was (24.5 ± 3.5) weeks, and the 24 women delivered at an average of (37.5 ± 1.4) gestational weeks.The eleven mild cases accepted mask oxygenation.For those 13 moderate or severe CDH cases, all received dexamethasone to promote fetal lung maturity at 32 gestational weeks, seven were intubated before clamp the cord, and the other six did after.These 13 babies accepted high-frequency oscillation ventilation, with a median duration of 58 hours, and some of them treated with inhaled nitric oxide on requirement with a median duration of 52 hours.Except two cases died before operation, the rest 22 cases underwent neonatal surgery.One moderate case died at 48 hours after surgery due to pulmonary hypertension and respiratory failure.Another one severe case withdrew treatment at two months old.The other 20 infants recovered fully.Conclusions Integrated management including prenatal diagnosis and postnatal treatment, provides an effective and streamlined mode for diagnosis and treatment of CDH.Therefore,it might minimize potential medical risks.