摘要目的 探讨导致先天性膈疝(congenital diaphragmatic hernia,CDH)死亡的危险因素.方法 回顾性分析近10年来诊断明确的37例CDH患儿,分析其临床特点和危险因素,利用非条件多元回归进行死亡危险因素分析.结果 37例患儿中有29例进行了手术,其中CDH总病死率为32.4％(12/37),手术病死率为13.8％ (4/29).存活组(25例)与死亡组(12例)间,在出生体重[(3.12±0.41)kg vs (2.66±0.65) kg]、住院年龄[(135.14 ±209.71)h vs (6.67 ±7.79)h]、住院时间[(16.52±6.23)d vs (1.25 ±1.38)d]、氧合指数[(239.55±115.95) mmHg vs (96.10±59.18) mmHg,1 mmHg=0.133 kPa]、早期产前诊断(3例vs 6例)、右侧膈疝(1例vs 4例)、心脏畸形(2例vs 6例)和持续性肺动脉高压(3例vs 7例)等差异有统计学意义(P＜0.05).通过多元回归分析,CDH的死亡危险因素分别为产前诊断(OR=20.97,95％ CI 1.60～ 275.78),低氧合指数(OR=18.12,95％ CI 0.80 ～ 123.12)和心脏畸形(OR=22.0,95％CI 1.46～332.32).结论 CDH有较高的病死率,死亡危险因素为产前诊断、低氧合指数和心脏畸形.

abstractsObjective To investigate the risk factors of congenital diaphragmatic hernia (CDH) deaths.Methods A retrospective study was conducted on 37 CDH patients during 10 years.Clinical characteristics and risk factors were compared and non-conditional logistic regression analysis was performed to determine independent predictors for mortality.Results Twenty nine patients,from a total of 37,underwent surgery for CDH.The total mortality rate in patients with CDH was 32.4％ (12/37) and the overall operative mortality was 13.8％ (4/29).There was a significant difference between CDH patients who survived (n =25) and those who died (n =12) in birth weight[(3.12±0.41) kg vs (2.66 ±0.65) kg],the age on admission [(135.14 ± 209.71) h vs (6.67 ± 7.79) h],hospital length of stay [(16.52 ± 6.23) d vs (1.25 ±1.38) d],oxygenation index[(239.55 ± 115.95) mmHg vs (96.10 ±59.18) mmHg,1 mmHg =0.133 kPa],early antenatal diagnosis (3 cases vs 6 cases),right congenital diaphragmatic hernia(1 cases vs 4 cases),cardiac malformations (2 cases vs 6 cases) and presence of persistent pulmonary hypertension of newborn (3 cases vs 7 cases) (P ＜0.05).Using logistic regression analysis,the following factors independently predicted mortality were antenatal diagnosis (OR =20.97,95％ CI 1.60 ～ 275.78),low oxygenation index (OR =18.12,95 ％ CI 0.80 ～ 123.12) and cardiac malformations (OR =22.0,95 ％ CI 1.46 ～ 332.32).Conclusion CDH patients have higher mortality.Risk factors for mortality in neonatal CDH are associated with early antenatal diagnosis,low oxygenation index and cardiac malformations.