抄録
Twenty-six patients with congenital diaphragmatic hernia who developed symptoms within the first 24 hours were reviewed. They were classified into the three groups according to the results of the pre-and post-operative blood gas analyses. Group 1 (9 patients): The preoperative AaDO_2 was lower than 500 mmHg. The post-operative course had been uneventful with no mortality. One patient developed persistent fetal circulation (PFC) which had been treated successfully. Group 2 (8 patients): The preoperative AaDO_2 was higher than 500 mmHg and the post-operative PaO_2 elevated higher than 200 mmHg shortly after operation. Half of them, however, developed PFC with three death. They had had so-call honeymoon period when high PaO_2 was maintained during several hours after the operation, and slipped into PFC with even minimum stimuli. Intensive cares including mechanical ventilation and administration of α-blockers were effective in these PFC patients. Group 3 (7 patients): The preoperative AaDO_2 was as high as that of the group 2, but there was no elevation in PaO_2 postoperatively. Neither respiratory care, nor pharmacologic treatment was effective in these patients. Hypoxia seen in these patients may be caused by possible hypoplastic lungs. There was no survivor in this group. In conclusion, the above mentioned classification may be useful to anticipate the outcome of these patients and to select the best therapeutic techniques which are available at the present moment.
