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0OUR EXPERIENCE IN PREOPERATIVE PREPARATION OF NEWBORNS FOR THE TREATMENT OF CONGENITAL DIAPHRAGMIC HERNIAS IN CHILDREN.
Mirmadiyev Mirfozil Shokir Ugli
SamDTU. Department of Pediatric Surgery No. 2 named after M.A. Akhmedov, Samarkand. Uzbekistan. https://doi.org/10.5281/zenodo.14513892
ARTICLE INFO
ABSTRACT
Qabul qilindi: 10- Dekabr 2024 yil Ma'qullandi: 15- Dekabr 2024 yil Nashr qilindi: 18- Dekabr 2024 yil
KEYWORDS
The manifestation of congenital diaphragmatic hernias in children often depends not on the stage of the disease, but on the stage of its onset and the occurrence and progression of secondary complications in each patient..
Congenital diaphragmatic hernias (CDH) occur in 2% of all types of hernias among children with various congenital diseases. Due to insufficient diagnostic capabilities, especially in the pre-hospital period, delayed diagnosis leads to the progression of disease complications. Often, these processes also result in delayed surgery, which significantly impacts the complexity of the operation, consequently increasing the number of postoperative complications and mortality rates. The overall state of medical care and the level of development of diagnostic methods in each region also play a significant role in the occurrence of such adverse events.
Actuality. Congenital diaphragmatic hernias (CDH) occur in 2% of all types of hernias among children with various congenital diseases. Due to insufficient diagnostic capabilities, especially in the pre-hospital period, delayed diagnosis leads to the progression of disease complications. Often, these processes also result in delayed surgery, which significantly impacts the complexity of the operation, consequently increasing the number of postoperative complications and mortality rates. The overall state of medical care and the level of development of diagnostic methods in each region also play a significant role in the occurrence of such adverse events.
The manifestation of congenital diaphragmatic hernias in children often depends not on the stage of the disease, but on the stage of its onset and the occurrence and progression of secondary complications in each patient.
Despite the annual development of medicine, according to a number of authors, the prevalence of congenital diaphragmatic hernias tends to increase. In children, congenital hernias are mainly diagnosed in combination with other developmental defects, such as: pulmonary aplasia, pulmonary hypoplasia, heart and respiratory failure. In children, other types of congenital hernias are mainly diagnosed: esophageal atresia, etc. [1.4].
The purpose of the research is: A comparative study of intensive care in both patient groups. A comparative assessment of intensive care in both patient groups.
Materials and methods: The study was based on an analysis of the diagnosis and treatment of 60 children with congenital diaphragmatic hernias (CDA) who were hospitalized
in the departments of neonatal surgery and general surgery of the Republican Specialized Scientific and Practical Medical Center for Emergency Medical Aid from 2000 to 2024. Of these, 27 (45%) were boys and 33 (55%) were girls. All patients were divided into 2 groups: Group I - a comparison group of 26 people, Group II - a main group of 34 people.
Research results: From the moment the sick children were admitted to the medical center, artificial lung ventilation was continued. This process was carried out in a mode of hyperventilation or normoventilation, with an average respiratory rate of 50-70 breaths per minute. When the condition was complicated by the development of pulmonary hypertension, non-selective pulmonary vasodilators were used (a 25% magnesium sulfate solution, a boosting dose of 50 mcg/kg, a loading dose of 250-300 mcg/kg). pH level by selecting a ventilation regime for the lungs 7.40, and pCO2 at a level not exceeding 30-40 mm Hg. Correction of volemic disorders was carried out by administering freshly frozen plasma or a 5% albumin solution at a rate of 10-15 ml/kg. This allowed for sufficient replenishment of plasma flow from blood vessels to tissues during hypoxia. In addition, inotropic drugs were prescribed to maintain blood pressure - 0.5% dopamine solution or 4% dopamine solution at a dose of 5-10 mcg/kg/min. Infuzion treatment was conducted with a 10% glucose solution and electrolyte solutions. The fight against metabolic acidosis was carried out by administering sodium bicarbonate solution in a microflow, the dose of which depended on the severity of acidosis. Antibacterial therapy was conducted from the moment the diagnosis was made. The operation was performed after the patient's condition stabilized, which was usually achieved through several days of intensive care. The technique of execution depended on each specific case. Adequate pain relief and myorelaxation were provided both before and after surgery. Full parenteral feeding for the first 3-5 days after surgery has been conducted. Artificial pulmonary ventilation (IPV) continued until independent adequate respiration was restored.[2]
Almost all newborns underwent mechanical ventilation in the preoperative period. The functioning of all the body's systems was constantly being adjusted. In the context of intensive care, the examination data and biometrics are insufficient for timely detection and correction of developing complications. Constant hardware and laboratory monitoring of the state of the infant's organs and systems comes to the forefront. The results of preparing newborns for surgery were evaluated based on data from physical examinations and the results of objective research methods. Particular attention was paid to: upon admission, the necessary level of HBG in group I was 74.4±3.07%, while in group II it was 70.6±3.7% (t=0.78; p>0.04). Before surgery, this indicator was 50.6±3.6% in group I and 30.5±3.3% in group II (t=3.07; p<0.002). Patients in Group I showed a statistically significant decrease in HGD as a result of intensive care (t=5.02; r<0,001). In group II, a statistically significant decrease in Fi02 (need for oxygen) was observed not only during preoperative preparation (t=8.06; p<0.001), but also significantly exceeded the dynamics of group I. A different dynamic was observed in terms of the highest respiratory pressure. When administered, the required PIP in group I was 27.4±3.62 mbar, while in group II it was 24.8±1.12 mbar (t=l.33; p>0.1). Before surgery, this indicator was 27.3±1.48 mbar in group I and 21.6±1.03 mbar in group II (t=3.18; p<0.005). According to the necessary results obtained upon admission, patients in group I achieved a statistically significant decrease in maximum respiratory pressure. Before surgery, this indicator was 27.3±1.48 mbar in group I and 21.6±1.03 mbar in group II (t=3.18; p<0.005).
According to the results obtained, patients in group I showed a statistically significant decrease in peak pressure, respiration, artificial lung ventilation was performed at a rate of 62.3±1.81 breaths per minute in group I upon admission to the hospital, while in group II it was performed at a rate of 58.4±2.15 breaths per minute (t=1.46; p>0.01). Before surgery, this indicator was 59.2±3.15 and 53.6±3.54 per minute, respectively.
Summaries: Thus, the respiratory rate of patients in both groups was maintained close to the physiological level for newborns. However, in group I, after intensive preoperative preparation, a proven decrease in the child's body's need for additional oxygen was achieved in "tender" ventilation regimes and to a lesser extent than in group II. Thus, no statistically significant differences in the baseline values of each indicator were found between the groups with similar respiratory rates in patients of both groups who underwent OVP. According to a number of indicators, statistically significant changes were achieved in groups I and II, identical in direction and amplitude. This is due to the unified goal, objectives, and methods of resuscitation and intensive care for both groups. In group I, after intensive preoperative preparation, "rigid" oxygen levels were achieved with ventilation strips and to a lesser extent compared to group II. No statistically significant differences were found in the initial values of each indicator between the groups. According to a number of indicators, statistically significant changes were achieved in groups I and II, identical in direction and amplitude. This is due to the unified goal, objectives, and methods of conducting intensive care and intensive care for both groups. The main difference was the preoperative period and the long duration of preparation. The average duration from the onset of diaphragmatic hernia symptoms to surgery was 18.8±1.45 hours in group 1 and 93.2±2.40 hours in group 2. Thus, preoperative preparation in patients of group I allowed for relative stability of homeostasis due to rigid OSV regimens and aggressive drug therapy. On the contrary, adequate training of children in Group II led to the stabilization of the state of life support systems from a minimum to a sufficient level, medical correction. Following preoperative preparation, the children underwent surgery. Readiness criterion the surgical intervention consisted of stable stabilization of the infant's condition for 4-6 hours. in extreme artificial respiration regimens, i.e., pH = 7.36-7.46, oxygen saturation 89-95%, mean arterial pressure was approximately 50 mmhb, and paCO was at least 30 mmhb.
Literature:
1. Puligandla P.S., Skarsgard E.D., Offringa M., Adatia I., Baird R., Michelle Bailey J.A., et al. The Canadian Congenital Diaphragmatic Hernia Collaborative, CMAJ. 2018;190(4):103-112. Doi: https://doi.org/10.1503/cmaj.170206.
2. Хаматханова, Е.М. Пути совершенствования качества медицинской помощи при врожден-ных пороках развития: автореф. дис. ... д-ра мед. наук: 14.01.19; 14.02.03 / Хаматханова Елизавета Мухтаевна.
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3. Машинец, Н.В. Диафрагмальная грыжа плода (диагностика, лечение, постнатальные ис-ходы) / Н.В. Машинец // Акушерство и гинекология. - 2016. - №2. - С. 20-26.
4. Burgos C.M., Frenckner B., Luco M., Harting M.T., Lally P.A., Lally K.P. Prenatally versus postnatally diagnosed congenital diaphragmatic hernia - Side, stage, and outcome. J Pediatr Surg. 2018. Doi: https://doi.org/10.1016/j.jpedsurg.2018.04.008.
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