Lü Junjian,Lin Tulian,Wu Qiang,et al.Prediction of extracorporeal membrane oxygenation in children with congenital diaphragmatic hernia by echocardiography[J].Journal of Clinical Pediatric Surgery,2021,20(09):814-818,824.[doi:10.12260/lcxewkzz.2021.09.003]
超声心动图对先天性膈疝患者接受体外膜肺氧合治疗的预测作用研究
- Title:
- Prediction of extracorporeal membrane oxygenation in children with congenital diaphragmatic hernia by echocardiography
- Keywords:
- Hernias; Diaphragmatic; Congenital/DI; Ultrasonography; Prenatal; Extracorporeal Membrane Oxygenation; Prognosis
- 分类号:
- R655.6;R540.45
- 摘要:
- 目的 探讨超声心动图对预测先天性膈疝（congenital diaphragmatic hernia，CDH）患者接受体外膜肺氧合（extracorporeal membrane oxygenation，ECMO）治疗的临床价值。方法 回顾性分析2017年1月至2020年12月广州市妇女儿童医疗中心新生儿外科收治的77例CDH患者资料。根据是否达到需要接受ECMO治疗的指征，分为非ECMO组58例，ECMO组19例。对比患者的胎龄、出生体重、性别、膈疝侧别等一般资料，并分析出生后24 h内的超声心动图对CDH患者接受ECMO治疗的预测作用。结果 两组患者的性别、出生体重、胎龄、膈疝侧别、是否产前诊断，以及超声心动图测量值中经房水平分流流束宽径（atrial horizontal shunt，AHS）、右心室内径（right ventricular diameter，RVD）、主肺动脉内径（main pulmonary artery diameter，MPAD）、左心室缩短分数（left ventricular fractional shortening，LVFS）、左心室射血分数（left ventricular ejection fraction，LVEF）比较，差异均无统计学意义（P>0.05）；两组是否肝脏疝入、有无PPHN，以及超声心动图测量值中经未闭动脉导管（patent ductus arteriosus，PDA）流束宽径、主动脉内径（aortic diameter，AOD）、左心房内径（left atrial diameter，LAD）、左心室收缩末期内径（left ventricular end-systolic diameter，LVESD）、左心室舒张末期内径（left ventricular end-diastolic diameter，LVEDD）比较，差异均有统计学意义（P<0.05）。通过逐步回归分析发现，肝脏疝入（OR=25.83，95%CI：1.46~456.26）、PDA增宽（OR=3.33，95%CI：1.03~10.81）、LAD缩小（OR=0.18，95%CI：0.05~0.67）是需要接受ECMO治疗的独立危险因素（P<0.05）。PDA值的ROC曲线下面积为0.890（95%CI：0.815~0.964，P<0.01），PDA=3.1 mm时预测CDH患者接受ECMO治疗的敏感度为100%，特异度为61.02%；LAD值的ROC曲线下面积为0.830（95%CI：0.722~0.937，P<0.01），LAD=7.5 mm时预测CDH患者接受ECMO治疗的敏感度为61.11%，特异度为93.22%。结论 出生后超声心动图对CDH患者是否需要接受ECMO辅助治疗有预测作用，可协助临床决策。
- Abstract:
- Objective To explore the predictive value of echocardiography in the treatment of congenital diaphragmatic hernia (CDH) with extracorporeal membrane oxygenation (ECMO).Methods From January 2017 to December 2020, clinical data were retrospectively reviewed for 77 CDH children.According to whether or not fulfilling the indications for adjuvant treatment with ECMO, they were divided into two groups of non-ECMO (n=58) and ECMO (n=19).The relationship between was examined between the need to receive ECMO adjuvant therapy and such general profiles as gestational age, birth weight, gender and affected sidenia, etc.And the postnatal predictive effect of echocardiography within 24 hours on the acceptance of ECMO therapy in CDH children.Results No significant inter-group differences existed in gender, birth weight, gestational age, affected side, prenatal diagnosis, atrial horizontal shunt (AHS), right ventricular diameter (RVD), main pulmonary artery diameter (MPAD), left ventricular fractional shortening (LVFS) or left ventricular ejection fraction (LVEF) (P>0.05).The inter-group differences of hepatic hernia, persistent pulmonary hypertension of newborn (PPHN), patent ductus arteriosus (PDA), aortic diameter (AOD), left atrial diameter (LAD), left ventricular end-systolic diameter (LVESD) and left ventricular end-diastolic diameter (LVEDD) on echocardiography were statistically significant (P<0.05).Stepwise regression analysis indicated that hepatic hernia (OR=25.83, 95%CI:1.46-456.26), higher PDA (OR=3.33, 95%CI:1.03-10.81) and lower LAD (OR=0.18, 95%CI:0.05-0.67) were independent risk factors for ECMO (P<0.05).The area under ROC curve of PDA value for requiring ECMO treatment was 0.890(95%CI:0.815-0.964, P<0.01) and the sensitivity and specificity were 100% and 61.02% with a PDA of 3.1 mm;The area under receiver operating characteristic (ROC) curve of LAD value for requiring ECMO treatment was 0.830(95%CI:0.722-0.937, P<0.01) and the sensitivity and specificity of ECMO treatment were 61.11% and 93.22% with a LAD of 7.5 mm.Conclusion Postnatal echocardiography may predict the need for ECMO in CDH children and assist in clinical decision-making.
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备注/Memo
收稿日期:2020-05-18。
基金项目:广东省自然科学基金-面上项目（编号：2020A1515010296）
通讯作者:钟微,Email:zhongwei@gwcmc.org