摘要
目的 探讨新生儿早期动脉血肺泡-动脉氧分压差(alveolar-arterial difference in oxygen pressure,AaDO2)预测先天性膈 疝(congenital diaphragmatic hernia,CDH)患儿需要体外膜肺氧合(extracorporeal membrane oxygenation,ECMO)支持的预测价值,以及AaDO2与临床结局之间的关系.方法 收集2016年1月至2024年2月广州医科大学附属妇女儿童医疗中心新生儿外科监护病房收治的新生儿CDH的临床资料进行回顾性分析,根据是否达到ECMO支持指征分为需ECMO组和不需ECMO组,比较两组患儿临床资料差异,采用多因素回归分析需ECMO支持的危险因素,并绘制生后6 h内AaDO2预测需要ECMO支持的受试者工作特征曲线,根据截断值分为高AaDO2组和低AaDO2组,应用Kaplan-Meier生存曲线、t检验比较两组患儿肺发育不良发生率和病死率的差异.结果 共纳入186例患儿,需ECMO组43例、不需ECMO组143例,多因素回归分析显示生后6 h内AaDO2增高是CDH患儿需要ECMO支持的独立危险因素(OR=1.058,95％CI 1.030～1.087,P＜0.05).受试者工作特征曲线分析显示,AaDO2预测CDH是否需要ECMO支持的最佳截点为32.2 kPa,曲线下面积为0.805(95％CI0.705～0.906).根据AaDO2截断值,分为高AaDO2组48例和低AaDO2组127例,两组比较,高AaDO2组需要ECMO支持率(66.7％比8.7％)、合并慢性肺疾病率(46.2％比9.2％)、高风险缺损率(C/D级缺损)(55.9％比11.6％)明显高于低AaDO2组,存活率(54.2％比93.7％)明显低于低AaDO2组,差异均有统计学意义(P＜0.05);高AaDO2组存活患儿中位住院时间明显长于低AaDO2组[32.5(19.8,64.5)d 比 17.0(12.0,24.0)d,P＜0.05].结论 CDH 患儿生后6 h 内动脉血 AaDO2增高是预测是否需要ECMO治疗的独立危险因素,高AaDO2患儿呼吸系统相关疾病发病率和病死率较高,可作为判断新生儿CDH预后的指标之一.
Abstract
Objective To study the clinical values of alveolar-arterial difference in oxygen pressure(AaDO2)in arterial blood gas(ABG)early after birth in predicting the need for extracorporeal membrane oxygenation(ECMO)and evaluating clinical outcomes in neonates with congenital diaphragmatic hernia(CDH).Methods From January 2016 to February 2024,patients with neonatal CDH admitted to our hospital were retrospectively reviewed.They were assigned into ECMO group and non-ECMO group according to ECMO indications.The data of the two groups were compared and multivariate regression analysis was used to analyze the risk factors of ECMO.Receiver operating characteristic(ROC)curve of AaDO2 predicting ECMO requirement within 6 h after birth was drawn.The patients were further assigned into high-AaDO2 group and low-AaDO2 group and the differences of morbidities and mortalities were compared.Results A total of 186 cases were enrolled,including 43 in the ECMO group and 143 in the non-ECMO group.Multivariate regression analysis showed that elevated AaDO2 within 6 h after birth an independent risk factor for ECMO in CDH patients(OR=1.058,95％CI 1.030-1.087,P＜0.05).ROC curve analysis revealed the optimal AaDO2 threshold was 32.2 kPa with the area under the curve(AUC)0.805(95％CI 0.705-0.906).The incidences of pulmonary hypertension requiring ECMO,chronic lung disease and high-risk diaphragmatic defects(grade C/D defects)in high-AaDO2 group were 66.7％,46.2％and 55.9％,respectively,significantly higher than low-AaDO2 group(8.7％,9.2％and 11.6％,all P＜0.05).The survival rate of high-AaDO2 group was significantly lower than low-AaDO2 group(54.2％vs.93.7％,P＜0.05).The median length of hospital stay of the survivors in high-AaDO2 group was significantly longer than low-AaDO2 group(32.5 d vs.17.0 d,P＜0.05).Conclusions Early AaDO2 is an independent risk factor predicting the need of ECMO in neonates with CDH.Patients with high AaDO2 have higher incidences of adverse respiratory morbidities and overall mortalities.High AaDO2 can be used as predictor of clinical outcomes.
维普
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