摘要目的:探讨先天性膈疝胎儿晚期总胎肺容积(total fetal lung volume，TFLV)与新生儿结局的相关性。方法:回顾性总结2013年9月至2018年12月我院产检诊断胎儿膈疝、并于胎龄32周后行胎儿磁共振成像的患儿资料，分析TFLV与新生儿结局的相关性。用于评价预后的指标包括是否需要体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)支持、存活率、是否出现肺动脉高压、术后机械通气时间及总住院时间。结果:共纳入37例先天性膈疝患儿，左侧膈疝33例，右侧4例，TFLV为(36.2±11.1)ml。6例(16.2%)生后需要ECMO支持，ECMO组TFLV低于非ECMO组[(24.9±8.2)ml比(38.4±10.3)ml， P＝0.005]，TFLV预测需ECMO支持的受试者工作特征曲线下面积为0.855，最佳界值点对应的TFLV为27.0 ml。总体存活率89.2%(33/37)，存活患儿TFLV高于死亡患儿[(38.1±10.1)ml比(21.1±5.5)ml， P＝0.002]。TFLV预测患儿存活的受试者工作特征曲线下面积为0.955，最佳界值点对应的TFLV为25.8 ml。TFLV与术后机械通气时间( P＝0.016)及总住院时间( P＝0.009)成负相关。肺动脉高压发生率为59.5%(22/37)，肺动脉高压组TFLV低于无肺动脉高压组[(32.1±10.8)ml比(42.2±8.6)ml， P＝0.005]。 结论:胎儿晚期通过磁共振成像测量TFLV对预测新生儿先天性膈疝存活率及是否需要ECMO支持具有较高的准确度。

abstractsObjective:To study the correlation between total fetal lung volume (TFLV) during late pregnancy and neonatal outcomes in congenital diaphragmatic hernia (CHD).Method:From September 2013 to December 2018, infants diagnosed with CDH during antenatal examination in our hospital were reviewed. All infants received fetal MRI examination after 32 weeks of gestational age. The correlation between TFLV and neonatal outcomes was analysed. The neonatal outcomes included extracorporeal membrane oxygenation (ECMO) therapy, survival rate, pulmonary hypertension (PH), postoperative mechanical ventilation duration and total hospital stay.Result:A total of 37 cases of CDH were enrolled in this study, included 33 left-sided CDH and 4 right-sided CDH, with a mean TFLV of (36.2±11.1) ml. 6 cases (16.2%) needed ECMO therapy after birth. TFLV in ECMO group was significantly lower than no-ECMO group [(24.9±8.2) ml vs. (38.4±10.3) ml, P=0.005]. The cut-off value for TFLV (cut-off 27.0 ml, AUC 0.855) was selected to predict the risk for ECMO therapy. The survival rate was 89.2% (33/37). TFLV in the survival group was significantly higher than the dead group [(38.1±10.1) ml vs. (21.1±5.5) ml, P= 0.002]. AUC for TFLV to predict survival was 0.955 with cut-off value of 25.8 ml. TFLV was negatively correlated with postoperative mechanical ventilation duration ( P=0.016) and total hospital stay ( P=0.009). The incidence of PH was 59.5%, and TFLV in the PH group was significantly lower than the no-PH group [(32.1±10.8) ml vs. (42.2±8.6) ml, P=0.005]. Conclusion:TFLV measured using fetal MRI in late pregnancy is useful for predicting survival and ECMO usage in neonates with CDH.