目的 分析先天性膈疝(CDH)患儿脑损伤的高危因素及预后,为临床对CDH患儿脑损伤的预测与干预提供依据。方法 采用回顾性分析方法,选取 2019年10月—2023年8月于西安交通大学第二附属医院入院并接受手术治疗的 83 例足月 CDH 患儿为研究对象。根据脑损伤综合征诊断标准分为脑损伤组(n=36)和对照组(n=47)。对两组新生儿一般资料、围生期资料、病程合并症及检查结果等资料进行比较;采用logistic回归分析探讨脑损伤高危因素。结果 脑损伤组与对照组的肺头比(t=4.335)、是否进行开放手术(χ2=4.196)以及是否合并肺动脉高压(χ2=5.397)比较,差异有统计学意义(P＜0.05)。Logistic回归分析显示,肺头比＜1.5(OR=8.171,95%CI:2.893～23.079,P＜0.001)、合并肺动脉高压(OR=4.069,95%CI:1.129～14.674,P=0.032)、采用开放手术(OR=3.517,95%CI:0.952～12.987,P=0.059,排除默认值为0.1)是CDH患儿发生脑损伤的独立危险因素。36例脑损伤组患儿中1例死亡,2例失访,24例预后良好,9例预后较差。结论 肺头比＜1.5、合并肺动脉高压及采用开放手术会显著增加CDH患儿脑损伤风险,对具有此类高危因素的患儿应强化监测与针对性干预,以优化预后。
Abstract
Objective To analyze the risk factors and prognosis of brain injury in neonates with congenital diaphragmatic hernia (CDH), in order to provide evidence for clinical prediction and intervention. Methods A retrospective analysis was conducted on 83 full-term CDH neonates who underwent surgical treatment at the Second Affiliated Hospital of Xi′an Jiaotong University from October 2019 to August 2023.Based on diagnostic criteria for brain injury syndrome, patients were divided into a brain injury group (n=36) and a control group (n=47).General neonatal data, perinatal records, comorbidities, and examination Results were compared between the two groups.Logistic regression analysis was used to identify high-risk factors for brain injury. Results Significant differences were observed between the brain injury and control groups in lung-to-head ratio (LHR) (t=4.335), open surgery (χ2=4.196), and pulmonary hypertension (χ2=5.397) (P<0.05).Logistic regression identified the following independent risk factors for brain injury: lung-to-head ratio <1.5 (OR=8.171, 95%CI: 2.893 - 23.079, P<0.001), pulmonary hypertension (OR=4.069, 95%CI: 1.129 - 14.674, P=0.032), and open surgery (OR=3.517, 95%CI: 0.952 - 12.987, P<0.1).Among the 36 brain injury cases, 1 died, 2 were lost to follow-up, 24 had favorable outcomes, and 9 had poor prognosis. Conclusions Lung-to-head ratio <1.5, pulmonary hypertension, and open surgery significantly increase the risk of brain injury in CDH neonates.Intensive monitoring and targeted interventions should be implemented for high-risk patients to improve prognosis.
关键词
先天性膈疝 /
脑损伤 /
肺头比 /
手术方式 /
新生儿
Key words
congenital diaphragmatic hernia /
brain injury /
lung-to-head ratio /
surgical approach /
neonates
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基金
陕西省科技攻关项目(2023-YBSF-547)
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