Neonatal Medicine

  • 제16권1호
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  • Pages.64-70
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  • 2009
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  • 2287-9412(pISSN)
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  • 2287-9803(eISSN)
대한신생아학회 (The Korean Society of Neonatology)
권호 표지

체외막형산소섭취로 치료한 선천성 횡경막 탈장 4례

Four Cases of Extracorporeal Membrane Oxygenation for Congenital Diaphragmatic Hernia

  • 김보은 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 하은주 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김영아 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김성국 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박정준 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 윤태진 (울산대학교 의과대학 서울아산병원 흉부외과학교실) ;
  • 김대연 (울산대학교 의과대학 서울아산병원 소아외과학교실) ;
  • 김성철 (울산대학교 의과대학 서울아산병원 소아외과학교실) ;
  • 이병섭 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김애란 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 김기수 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 피수영 (울산대학교 의과대학 서울아산병원 소아과학교실) ;
  • 박성종 (울산대학교 의과대학 서울아산병원 소아과학교실)
  • Kim, Bo-Eun (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Ha, Eun-Ju (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Young-A (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Seong-Uk (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Park, Jeong-Jun (Department of Thoracic & Cardiovascular Surgery, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Yun, Tae-Jin (Department of Thoracic & Cardiovascular Surgery, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Dae-Yeon (Department of Pediatric Surgery, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Seong-Chul (Department of Pediatric Surgery, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Lee, Byong-Sop (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Ellena (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Kim, Ki-Soo (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Pi, Soo-Young (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center) ;
  • Park, Seong-Jong (Department of Pediatrics, University of Ulsan, College of Medicine, Asan Medical Center)
  • 발행 : 2009.05.31

⟨ 이전 논문 다음 논문 ⟩

초록

선천성 횡경막 탈장은 급성 저산소증 호흡부전으로 인해 사망률이 매우 높은 질환으로 고빈도 인공 환기요법, 인산화질소 흡입요법 등이 치료 효과를 보이고 있다. 이러한 적극적인 치료에도 반응하지 않는 심한 선천성 횡경막 탈장에 대해서는 체외막형산소섭취(Extracorporeal membrane oxygenation, ECMO)가 유일한 치료 방법이다. 하지만 국내에서는 선천성 횡경막 탈장 환아에서 ECMO 적용 사례가 많지 않아 저자는 ECMO를 적용한 선천성 횡경막 탈장 4례를 문헌 고찰과 함께 보고하는 바이다

Congenital diaphragmatic hernia (CDR) with severe pulmonary hypoplasia is associated with significant mortality. Recently, several new therapeutic methods have been suggested, such as high-frequency oscillatory ventilation and inhaled nitric oxide. For hypoxemic respiratory failure unresponsive to these advanced medical treatment options, extracorporeal membrane oxygenation (ECMO) serves as the last potentially effective treatment. An understanding of the pathophysiology of pulmonary hypertension associated with CDH led to a strategy involving preoperative stabilization and delayed surgical intervention with ECMO. We describe four cases of ECMO, including the first report of ECMO for neonatal CDH in Korea.

키워드

참고문헌

  1. Beresford MW, Shaw NJ. Outcome of congenital diaphragmatic hernia. Pediatr Pulmonol 2000;30: 249-56. https://doi.org/10.1002/1099-0496(200009)30:3<249::AID-PPUL9>3.0.CO;2-9
  2. Clark RH, Hardin WD Jr., Hirschl RB, Jaksic T, Lally KP, Langham MR Jr., et al. Current surgical management of congenital diaphragmatic hernia: a report from the Congenital Diaphragmatic Hernia Study Group. J Pediatr Surg 1998;33:1004-9. https://doi.org/10.1016/S0022-3468(98)90522-X
  3. Colvin J, Bower C, Dickinson JE. Sokol J. Outcomes of congenital diaphragmatic hernia : a polpulalion-based study in Western Australia. Pediatrics 2005; 116;356-63. https://doi.org/10.1542/peds.2004-2845
  4. Stege G, Fenton A, Jaffray B. Nihilism in the 1990s: the true mortality of congenital diaphragmatic hernia. Pediatrics 2003;112;532-5. https://doi.org/10.1542/peds.112.3.532
  5. Rothenbach P, Lange P, Powell D. The use of extracorporeal membrane oxygenation in infants with congenital diaphragmatic hernia. Semin Perinatol 2005:29:40-4. https://doi.org/10.1053/j.semperi.2005.02.006
  6. Puri P, Gorman F. Lethal nonpulmonary anomalies associated with congenital diaphragmatic hernia: implications for early intrauterine surgery. J Pediatr Surg 1984;19;29-32. https://doi.org/10.1016/S0022-3468(84)80010-X
  7. Witters I, Legius E, Moerman P, Deprest J, Van Schoubroeck D, Timmerman D, et al. Associated malformations and chromosomal anomalies in 42 cases of prenatally diagnosed diaphramatic hernia. Am J Med Genet 2001;103:278-82. https://doi.org/10.1002/ajmg.1564
  8. Bartlett RH, Gazzaniga AB, Jefferies MR, Huxtable RF, Haiduc NJ, Fong SW. Extracorporeal membrane oxygenation (ECMO) cardiopulmonary support in infancy. Trans Am Soc Artif Intern Organs 1976;22:80-93.
  9. German JC, Gazzaniga AB, Amlie R, Huxtable RF, Bartlett RH. Management of pulmonary insufficiency in diaphragmatic hernia using extracorporeal circulation with a membrane oxygenator (ECMO). J Pediatr Surg 1977;12:905-12. https://doi.org/10.1016/0022-3468(77)90600-5
  10. West KW, Bengston K, Rescorla FJ, Engle WA, Grosfeld JL. Delayed surgical repair and ECMO improves survival in congenital diaphragmatic hernia. Ann Surg 1992;216:454-62. https://doi.org/10.1097/00000658-199210000-00009
  11. Khan AM, Lally KP. The role of extracorporeal membrane oxygenation in the management of infants with congenital diaphragmatic hernia. Semin Perinatol 2005;29:118-22. https://doi.org/10.1053/j.semperi.2005.04.005
  12. Choi SD. Extracorporeal Membrane Oxygenation (ECMO) in neonates. J Korean Pediatr Soc 2003; 46:731-5.
  13. Dimmitt RA, Moss RL, Rhine WD, Benitz WE, Henry MC, Vanmeurs KP. Venoarterial versus venovenous extracorporeal membrane oxygenation in congenital diaphragmatic hernia: the Extracorporeal Life Support Organization Registry, 1990-1999. J Pediatr Surg 2001;36:1199-204. https://doi.org/10.1053/jpsu.2001.25762
  14. Kugelman A, Gangitano E, Pincros J, Tantivit P, Taschuk R, Durand M. Venovenous versus veno arterial extracorporeal membrane oxygenation in congenital diaphragmatic hernia. J Pediatr Surg 2003;38:1131-6. https://doi.org/10.1016/S0022-3468(03)00256-2
  15. Harrington KP, Goldman AP. The role of extra-corporeal membrane oxygenation in congenital diaphragmatic hernia. Semin Pediatr Surg 2005;14:72- 6.
  16. Downard CD, Betit P, Chang RW, Garza JJ, Arnold JH, Wilson JM. Impact of AMICAR on hemorr hagic complications of ECMO: a ten-year review. J Pediatr Surg 2003;38:1212-6. https://doi.org/10.1016/S0022-3468(03)00270-7
  17. Davis PJ, Firmin RK, Manktelow B, Goldman AP, Davis CF, Smith JH, et al. Long-term outcome following extracorporeal membrane oxygenation for congenital diaphragmatic hernia: the UK experience. J Pediatr 2004;144:309-15. https://doi.org/10.1016/j.jpeds.2003.11.031