摘要
目的分析影响早产儿动脉导管未闭（PDA）的相关因素，探讨手术结扎动脉导管的最佳时间。方法研究2011年2月至2013年1月在北京军区总医院附属八一儿童医院极早产新生儿监护病房住院的353例胎龄〈32周伴PDA的早产儿。其中出生48h，心血管灌注评分系统（CVD）评分i〉3分的患儿，给予1—3个疗程布洛芬治疗，药物使用禁忌或药物治疗失败患儿，进行手术结扎。分析胎龄、出生体质量、症状性低血压、不同药物／手术治疗方案，是否与临床结局、坏死性小肠结肠炎（NEC）、脑室内出血（IVH）、早产儿视网膜病（ROP）或支气管肺发育不良（BPD）（纠正胎龄36周）相关。应用SPSS17．0软件，各组数据使用Kruskal-Walls秩和检验；2组数据比较，数量变量采用Wilcoxon符号秩检验，两分法变量采用Ⅳ。检验及Fisher’s确切检验，多组比较采用Friedman秩和检验及Halton模式，并通过Logistic回归模式逐步分析。结果PDA患儿，若出生持续CVD评分≥3分，随时间的延长，布洛芬促进PDA的效率降低，PDA与BPD（OR=3．163，P=0．002）、ROP（OR=2．557，P=0．007）发生率显著相关，需手术的可能性增高。CVD评分≥3分通过1、2疗程布洛芬治疗有效者分别为169例（47．9％）、52例（14．7％）；44例（12．5％）在药物治疗失败后，需手术治疗。手术组对比药物治疗组，胎龄较小[（29．4±2．4）周比（30．7±1．4）周，P〈0．0001]，体质量较低[（1450±577）g比（1750±508）g，P=0．004]。结论早产儿PDA持续时间越长，发生IVH、ROP、BPD可能性越高。使用2个疗程的布洛芬治疗后，若CVD评分仍i〉3分，应进行外科结扎PDA以改善临床表现，减少BPD及ROP的发生。PDA手术结扎是安全有效的。
Objective To define the variables associated with preterm infants with patent ductus arteriosus （PDA） and identify the optimal timing for PDA closure clinically. Methods Three hundred and fifty - three prema- ture babies with gestational age 〈 32 weeks in Ba Yi Children＇s Hospital,Beijing Military General Hospital,from Feb- mary 2011 to January 2013 were selected. Among them the PDA patients with degree of cardiovascular dysfunction u- sing a scoring system （CVD） ≥3 scores at 48 hour life by using the cardiovascular dysfunction scoring systerm received primary drug treatment with 1 -3 cycles Ibuprofen. If drug treatment failed or contraindicated, underwent surgical clo- sure. Gestational age, body weight, presence of symptomatic hypotension, drug treatment or surgical closure were ana- lyzed to see whether these factors were related to clinical outcomes, including hospital mortality, necrotizing enterocolitis （ NEC ）, intraventricular hemorrhage （ IVH ）, retinopathy （ROP） and bronchopulmonary dysplasia （ BPD ） at 36 weeks. Data were analyzed with Kruskal - Walls test, Wilcoxon signed rank test, Pearson X2 test, Fisher＇s exact test, Friedman, Halton,Logistic regression model. Results In the PDA patients with CVD ≥3 scores persistently, the effectiveness of Ibuprofen was lower as time went on, PDA and BPD （ OR = 3.163, P = 0. 002 ）, ROP （ OR = 2. 557, P = 0. 007 ） were re- lated markedly, and surgical treatment was possibly required. When CVD scores i〉 3 after birth, drug treatment for one cycle was effective in 169 cases（47.8% ） ,52 cases （ 14.7% ） for two cycles,and 44 cases（ 12.5% ） required surgical ligation after drug treatment failed. Such patients had younger gestational age [ （29.4± 2.4） weeks vs （ 30.7 ± 1.4 ） weeks, P 〈 0. 000 1 ], and lower body weight at birth [ （ 1 450 ± 577 ） g vs （ 1 750 ± 508） g, P = 0. 004）. Conclusions The prolonged patency of the ductus arteriosus in preterm infants is related to an increase for IVH,
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2015年第11期823-827,共5页
Chinese Journal of Applied Clinical Pediatrics
关键词
婴儿
早产
动脉导管未闭
治疗
时机
Infant, preterm
Patent ductus arteriosus
Therapy
Patent time
