Wang Weipeng,Pan Weihua,Wang Jun.Assessing perinatal prognostic risks for children with congenital diaphragmatic hernia[J].Journal of Clinical Pediatric Surgery,2019,18(11):977-983.[doi:10.3969/j.issn.1671—6353.2019.11.016]
先天性膈疝患儿围产期预后风险评估的研究进展
- Title:
- Assessing perinatal prognostic risks for children with congenital diaphragmatic hernia
- Keywords:
- Hernia; Diaphragmatic/CN; Perinatal Period; Prognosis; Risk Assessment
- 分类号:
- R726.1;R655.6;R730.7
- 摘要:
- 先天性膈疝（congenital diaphragmatic hernia，CDH）是指因胚胎时期膈肌发育停顿导致膈肌缺损、腹腔脏器疝入胸腔的一种先天性疾病，发生率为1/5 000~1/2 000[1]。尽管近年来诊疗理念和技术不断革新，CDH的生存率得到逐渐提高，但重症膈疝的死亡率仍高达40%~60%，其致死的主要原因是肺发育不良和肺动脉高压[1]。因此，早期准确评估CDH患儿病情及预后有助于指导产前咨询和胎儿期干预治疗，对围产期处理、产后新生儿诊疗、手术时机和具体手术方案的拟定具有重要的指导意义。常用的几种风险评估模型包括：胎儿肺头比（lung-to-head ratio，LHR）、O/E LHR（observed to expected lung area-to-head ratio）、肝脏位置及肝脏疝入胸腔比例、MRI测量总肺体积（total fetal lung volume，TFLV）、Apgar评分和出生体重、新生儿急性生理学评分-Ⅱ（score for neonatal acute physiology，version II，SNAP-Ⅱ）和新生儿急性生理学评分围产期补充-Ⅱ（simplified version of the score for neonatal acute physiology perinatal extension，SNAPPE-Ⅱ）、膈肌缺损大小等，本文拟针对目前常用几种风险评估模型在先天性膈疝患儿围产期预后风险评估中的应用进行综述。
- Abstract:
- Congenital diaphragmatic hernia(CDH)is a congenital disease caused by diaphragmatic muscle defect caused by pause of diaphragmatic muscle during embryonic period and abdominal cavity into chest cavity.The incidence rate is estimated at 1/5 000 to 1/2 000[1].With the continuous improvement of the concept and technology of diagnosis and treatment in recent years,the survival rate of CDH has gradually improved.However,the mortality rate of severe CDH is still as high as 40% to 60%.The major causes of mortality are pulmonary dysplasia and pulmonary hypertension.Therefore early accurate assessments of CDH may aid prenatal consultations and fetal interventions and have important guiding implications for perinatal management,postpartum neonatal diagnosis & treatment,surgical timing and specific surgical approaches.Several commonly used risk assessment models include lung-to-head ratio(LHR),O/E LHR(observed to expected lung area-to-head ratio),liver position,ratio of liver herniating into chest,MRI measurement of total fetal lung volume(TFLV),Apgar score,birth weight,(Score for neonatal acute physiology,version Ⅱ,SNAP-Ⅱ)and simplified version of score for neonatal acute physiology perinatal extension(SNAPPE-Ⅱ)and the size of the diaphragmatic defect,etc.
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备注/Memo
收稿日期:2018-09-12。
基金项目:上海交通大学医学院"紧缺专业硕士研究生临床研究能力提升计划"课题（编号：JQ201708）
通讯作者:王俊,Email:wangjun@xinhuamed.com.cn