新生儿先天性膈疝修补术后肺功能的近中期随访

Recent and mid-term follow-up of pulmonary function in neonates with congenital diaphragmatic hernia repair

摘要:

目的： 探究先天性膈疝患儿于新生儿期行膈疝修补术后近中期肺功能的变化。方法： 收集2009年1月至2016年3月在新生儿期于重庆医科大学附属儿童医院接受先天性膈疝修补手术的患儿临床资料及术后肺功能随访数据，共取得有效报告27份。根据肺功能测量方法的不同，将患儿分为婴幼儿组（0～3岁，肺功能测量方法为潮气容积分析和婴幼儿体描箱试验，12例）和年长儿组（3岁以上，指令性呼气测量，15例）。从儿保科选取0～3岁健康婴幼儿（12例）作为婴幼儿对照组。结果： 婴幼儿组中患儿术后肺功能的达峰时间比（percent of expiratory time to peak tidal time，tPTEF% tE）、达峰容积比（percentage of tidal volume to peak tidal expiratory flow，VPEF%VE）、吸呼时间比（the ratio of inspiratory time to expiratory time，Ratio tI to tE）、25%潮气容积的呼气流速（expiratory flow in 25% tidal flow，TEF 25%）均低于婴儿对照组（P<0.01）。年长儿组中患儿肺功能的一秒率（force expiratory volume in one second/forced vital capacity，FEV1/FVC）、最大呼气流速（peak expiratory flow，PEF）和75%肺活量最大呼气流量（maximal expiratory flow at 75% of forced vital capacity，MEF75）属正常范围，但低于正常预测值（P<0.01）。结论： 新生儿期接受先天性膈疝修补手术的患儿，在婴幼儿期随访肺功能仍有异常，主要表现为小气道阻塞。肺功能随年龄增长有改善，年长儿肺功能的部分测值仍低于正常预测值，但处于正常范围。

Abstract:

Objective: To investigate the recent and mid-term pulmonary function changes in neonates with congenital diaphragmatic hernia repair. Methods: From January 2009 to March 2016, the clinical data and follow-up data of postoperative pulmonary function of children who underwent congenital diaphragmatic hernia repair in our hospital were collected, and 27 valid reports were obtained. According to different lung function measurement methods, they were divided into infant group (aged 0-3 years, 12 cases were measured by tidal volume analysis and infant box test) and older children group (aged over 3 years, 15 cases were measured by mandatory breath measurement). Healthy infants (12 cases) aged 0 to 3 years were selected as the infant control group. Results: For the infant group, tPTEF% tE, VPEF% VE, Ratio tI to tE and TEF 25% were lower than those in the infant control group. For the older children group, FEV1/FVC, PEF and MEF75 of the children were within the normal range, but lower than the normal predicted values (P<0.01). Conclusion: Pulmonary function test shows obstructive lesions of the small airway in the neonates with congenital diaphragmatic hernia repair. The pulmonary function improves with the increase of age, and becomes normalized in older children, whereas there are some values still a little lower than predicted values.