Buradasınız

Konjenital diafragma hernisinde yaşam prediktörleri: 10 yıllık deneyimin multivariate analizi

Survival Predictors In Congenital Diaphragmatic Hernia: Multivariate Analysis Of a 10-Year Experience

Journal Name:

Publication Year:

Keywords (Original Language):

Abstract (2. Language): 
The purpose of this study was to establish a method by which independent predictors of survival could be determined and used to select CDHpatients who may benefit from rescue therapy. Data from our 10-year, single institutional experience of 62 infants with CDH were analyzed. Fifteen preoperative and seven intraoperative variables were analyzed. Stepwise logistic regression analysis yielded a prediction equation with four independent, statistically significant (P<0.05) predictors of survival: lower VI, higher BW, higher 5-minute APGAR, and lower PaCO2. Using a survival probability of <20%, this equation yielded a sensitivity of 94% and specificity of 82% in selecting those patients with CDH who failed conventional management. We conclude that the preoperative values for VI, BW, 5-minute APGAR, and PaCO2 of neonates with CDH in our institution can be used to select those patients with predicted high mortality who may benefit from salvage therapy. [Journal of Turgut Özal Medical Center 1997;4(2):225-229]
Abstract (Original Language): 
Bu çalışmanın amacı KDH'li hastalarda kurtarma tedavisine almak için hangi bağımsız yaşam prediktörlerinin olduğunun ve kullanılabileceğinin tespiti için bir metod geliştirmekti. Merkezimizin 10 yıllık bir süredeki 62 hastasının verileri analiz edildi. 15 preoperatif ve 7 intraoperatif değişken incelendi. Stepwise lojistik regresyon analizi dört adet bağımsız, istatistiksel olarak anlamlı (P<0.05) yaşam prediktörü olduğu sonucunu verdi: düşük VI, yüksek DA, yüksek 5 dakika APGAR sonucu ve düşük PaC02. Yaşam probabilitesi %20'den küçük kriterini kullanarak yapılan değerlendirme konvansiyel tedaviden fayda görmeyecek KDH'li vakaların değerlendirilmesinde %94 sensitivite ve %82 spesifite sonucunu verdi. Sonuç olarak VI in preoperatif değeri, DA, 5 dakika APGAR, ve PaC02 kurtarma tedavisinden fayda görebilecek, yüksek mor t al it e öngörülen yenidoğanların seçiminde kullanılabilir düşüncesindeyiz. [Turgut Özal Tıp Merkezi Dergisi 1997;4(2):225-229]
225-229

REFERENCES

References: 

1. Stauffer UG, Rickham PP: Congenital diaphragmatic hernia and eventration of the diaphragm. In Rickham PP, Lister J, Irvings JM editors. Neonatal Surgery. London: Butterworth, 1978: 163-78.
2. de Lorimier AA: Diaphragmatic hernia, in Ashcraft K, Holder T editors. Pediatric Surgery 2nd Ed, chap 19. Philadelphia: WB Saunders, 1993: 204-17.
3. Langer JC, Filler RM, Bohn DJ, et al. Timing of surgery for congenital diaphragmatic hernia. Is emergency operation
necessary? J Pediatr Surg 1988; 23:731-4.
4. Hazebroek FWJ, Tibboel D, Bos AP, et al. Congenital
diaphragmatic hernia: Impact of preoperative stabilization. J
Pediatr Surg 1988; 23:1139-46.
5. Nakayama DK, Motoyama EK, Tagge EM. Effect of preoperative stabilization on respiratory system compliance and outcome in newborn infants with congenital diaphragmatic hernia. J Pediatr 1991;118:793-9.
6. Wilson JM, Lund DP, Lillehei CW, et al. Delayed repair and preoperative ECMO does not improve survival in high-risk congenital diaphragmatic hernia. J Pediatr Surg 1992;
27:368-75.
7. Breaux CW, Rouse TM, Cain WS, et al. Congenital diaphragmatic hernia in an era of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization: a prognostic and management classification. J
Pediatr Surg 1992; 27: 1192-6.
8. Karl SR, Ballantine TVN, Snider MT. High-frequency
ventilation at rates of 375 to 1800 cycles per minute in four
Gürsoy
H
, et al.
Survival predictors in congenital diaphragmatic hernia
neonates with congenital diaphragmatic hernia. J Pediatr Surg 1983;18:822- 6.
9. Fujino Y, Takezawa J, Nishimura I, et al. High frequency oscillation for persistent fetal circulation after repair of congenital diaphragmatic hernia. Crit Care Med 1989;
17:376-77.
10. Gibson C, Fonkalsrud EW. Iatrogenic pneumothorax and mortality in congenital diaphragmatic hernia. J Pediatr Surg
1983;18:555-9.
11. Stolar CJH, Price ME, Butler MW, et al. Management of
infants with congenital diaphragmatic hernia using ECMO. In: Arensman RM, Cornish JD editors. Extracorporeal Life Support, chap 17. Boston: Blackwell Scientific 1993: 252¬61.
12. Breaux CW, Rouse TM, Cain WS. et al. Improvement in survival of patients with congenital diaphragmatic hernia utilizing a strategy of delayed repair after medical and/or extracorporeal membrane oxygenation stabilization. J
Pediatr Surg 1991; 26:333-8.
13. Finer NN, Etches PC, Kamstra B, et al. Inhaled nitric oxide in infants referred for extracorporeal membrane oxygenation: Dose response. J Pediatr 1994; 124:302-8.
14. Ortiz RM, Cilley RE, Bartlett RH. Extracorporeal
membrane oxygenation in pediatric respiratory failure.
Pediatr Clin North Am 1987;34:39-46.
15. Bohn DJ, James I, Filler RM, et al. The relationship between PaCO2 and ventilation parameters in predicting survival in congenital diaphragmatic hernia. J Pediatr Surg
1984;19:666-71.
16. Bohn D, Tamura M, Perrin D, et al. Ventilatory predictors of pulmonary hypoplasia in congenital diaphragmatic hernia, confirmed by morphological assessment. J Pediatr
1987; 111 :423-31.
17. Marinelli P: Mean airway pressure calculation. J Pediatr 1981;99: 169.

Thank you for copying data from http://www.arastirmax.com