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浙江大学学报（医学版）
J Zhejiang Univ (Med Sci)  2019, Vol. 48 Issue (1): 83-88    DOI: 10.3785/j.issn.1008-9292.2019.02.13
    
Risk factors of death in newborns with congenital diaphragmatic hernia
CHEN Dong1(),HU Yuanjun2,WU Yurui3,LI Xiaoying1()
1. School of Computer Science and Information Security，Guilin University of Electronic Technology，Guilin 541004，Guangxi Zhuang Autonomous Region，China1.Neonatal Intensive Care Unit, Qilu Children s Hospital of Shandong University, Jinan 250022, China
2.Department of Neonate Surgery, Qilu Children s Hospital of Shandong University, Jinan 250022, China
3.Department of Thoracic and Oncological Surgery (Department of Minimally Invasive Surgery), Qilu Children s Hospital of Shandong University, Jinan 250022, China
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Abstract   Objective

To investigate risk factors of death in newborns with congenital diaphragmatic hernia (CDH).

 Method

A total of 126 newborns with CDH from June 2012 to September 2018 were enrolled. Concomitant malformations were recorded by descriptive analysis. Newborns received surgical treatment (n=120) for CDH were divided into survival group and fatal group. The risk factors of death were analyzed by univariate and multivariate logistic regression and the ROC curve with generated with relevant variables.

 Result

There were 55 CDH newborns with concomitant malformations (43.7%), including 20 cases (15.9%) with multi-malformation. Logistic regression analysis showed that premature rupture of membranes (PROM), postoperative atelectasis, long duration of postoperative mechanical ventilation, postoperative high oxygenation index (OI) were related to death (all P＜0.05), and the delayed surgery was a protective factor (P＜0.05). In ROC analysis of postoperative OI in predicting death, the area under the curve (AUC) was 0.841, with the cutoff value of 5.74, the sensibility and specificity of OI was 81.0% and 75.0%, respectively(P＜0.01).

 Conclusions

Newborns with CDH have a high rate of malformations. The risk factors of death were PROM, postoperative atelectasis, postoperative long duration of mechanical ventilation and higher postoperative OI, and delayed surgery may reduce mortality.

Key words： Hernias, diaphragmatic, congenital/complications      Infant, newborn      Congenital abnormalities/etiology      Cause of death      Risk factors     
Received: 20 October 2018      Published: 10 May 2019
CLC:  R725.6  
  R655.6  
Corresponding Authors: LI Xiaoying     E-mail: chen0614@163.com;lxy_jn@sina.com
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CHEN Dong
HU Yuanjun
WU Yurui
LI Xiaoying
Cite this article:

CHEN Dong,HU Yuanjun,WU Yurui,LI Xiaoying. Risk factors of death in newborns with congenital diaphragmatic hernia. J Zhejiang Univ (Med Sci), 2019, 48(1): 83-88.

URL:

http://www.zjujournals.com/med/10.3785/j.issn.1008-9292.2019.02.13     OR     http://www.zjujournals.com/med/Y2019/V48/I1/83


先天性膈疝患儿死亡危险因素分析

目的

分析先天性膈疝（CDH）患儿术后死亡的危险因素。

 方法

纳入2012年6月至2018年9月山东大学齐鲁儿童医院收治的CDH患儿共126例，描述性分析合并畸形情况。接受手术治疗的120例CDH患儿分为存活组（100例）和死亡组（20例），采用单因素分析及多因素Logistic回归分析的方法分析患儿死亡的危险因素，并对多因素Logistic回归分析有统计学意义的计量资料进行ROC曲线分析。

 结果

126例患儿中，合并先天缺陷55例（43.7%），其中多发畸形20例（15.9%）。单因素和多因素Logistic回归分析结果显示，延期手术为保护性因素 （P＜0.05）；胎膜早破、术后肺不张、术后上机时间长及术后氧合指数高为危险因素（均P＜0.05）。ROC曲线分析结果显示，当临界值为5.74时，术后氧合指数预测患儿死亡的敏感度为81.0%，特异度为75.0%，曲线下面积为0.841（P＜0.01）。

 结论

CDH患儿常并发畸形，胎膜早破、术后肺不张、术后上机时间、术后氧合指数大于5.74是CDH患儿术后死亡的高危因素，通过延期手术获得术前稳定的内环境，可以有效降低CDH患儿术后死亡率。

关键词： 疝，横膈，先天性/并发症,  婴儿，新生,  先天畸形/病因学,  死亡原因,  危险因素 
先天缺陷类型 例次 先天缺陷类型 例次
肺发育缺陷 41(32.5) 外观发育缺陷 7(5.6)
患侧肺发育不良 38(30.2) 先天性唇腭裂 2(1.6)
肺隔离症 2(1.6) 皮-罗综合征 2(1.6)
肺囊性病变 1(0.8) 指（趾）畸形 2(1.6)
心脏结构发育缺陷 19(15.1) 先天愚型 1(0.8)
房室间隔缺损 19(15.1) 先天性遗传代谢病 1(0.8)
消化道发育缺陷 6(4.8) 异戊酸血症 1(0.8)
肠旋转不良 5(3.9) 其他发育缺陷 3(2.4)
肛门狭窄 1(0.8) 乳糜胸 2(1.6)
中枢神经发育缺陷 1(0.8) 胸腔异位肾 1(0.8)
脑发育不良 1(0.8)
Table 1 Concomitant malformations of congenital diaphragmatic hernia
组　别 n 男　性 胎龄（周） 出生体质量（kg） 低阿普加评分* 羊水多 胎膜早破 母亲年龄 手术时体质量（kg）
死亡组 20 12(60.0) 40(39,40) 3.4(3.3,3.4) 1(5.0) 1(5.0) 11(55.0) 28(27,33) 3.13(3.05,3.25)
存活组 100 52(52.0) 39(38,40) 3.1(2.9,3.4) 12(12.0) 20(20.0) 12(21.0) 30(28,33) 2.98(2.83,3.4)
χ 2/Z值 — 0.429 2.022 2.564 0.845 2.597 9.852 0.342 0.569
P值 — ＞0.1 ＞0.1 ＞0.1 ＞0.1 ＞0.1 ＜0.01 ＞0.1 ＞0.1
组　别 n 左侧膈疝 延期手术# 术前PPHN 术后气胸 术后肺不张 术后上机时间 术后氧合指数△ 合并畸形
死亡组 20 15(75.0) 4(20.0) 16(80.0) 13(65.0) 7(35.0) 8(3,13) 6.7(5.6,9.6) 15(75.0)
存活组 100 80(80.0) 57(57.0) 29(29.0) 35(35.0) 5(5.0) 3(5,2) 3.8(3.1,5.4) 35(35.0)
χ 2/Z值 — 0.253 9.129 18.496 6.250 16.667 27.429 16.179 10.971
P值 — ＞0.1 ＜0.01 ＜0.01 ＜0.05 ＜0.01 ＜0.01 ＜0.01 ＜0.01
Table 2 Univariate analysis of risk factors for death of children with congenital diaphragmatic hernia received surgery
因　素 β SE Wald P OR 95% CI
胎膜早破 2.131 0.879 5.874 ＜0.05 0.119 0.021～0.665
延期手术* -1.934 0.923 4.387 ＜0.05 6.915 1.132～42.232
术前PPHN 1.212 0.863 1.973 ＞0.05 0.298 0.055～1.614
术后气胸 0.759 0.845 0.807 ＞0.05 0.468 0.089～2.452
术后肺不张 2.928 1.255 5.444 ＜0.05 0.054 0.005～0.626
术后上机时间长 0.439 0.169 6.756 ＜0.01 0.645 0.463～0.898
术后氧合指数高# 0.080 0.039 4.183 ＜0.05 0.923 0.855～0.997
先天缺陷 1.603 0.911 3.092 ＞0.05 0.201 0.034～1.201
常数 6.858 1.714 16.004 ＜0.01 951.031 —
Table 3 Logistic regression of risk factors for death of children with congenital diaphragmatic hernia received surgery
Figure 1 ROC curves of postoperative exygenation index in predicting death of children with congnital diaphragmatic hernia recieved surgery
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