摘要
目的探讨极早产儿床旁动脉导管未闭(patent ductus arteriosus,PDA)结扎术围术期状态对支气管肺发育不良(bronchopulmonary dysplasia,BPD)发生率的影响,并评估在新生儿重症监护病房(neonatal intensive care unit,NICU)床旁进行手术的安全性。方法收集2015年5月至2018年4月在解放军总医院第七医学中心附属八一儿童医院极早产NICU进行床旁PDA结扎术、胎龄在28～31+6周、出生体重在1 500 g以下的极早产儿共44例,按出院诊断分为BPD组(29例)和无BPD组(15例),对两组患儿胎龄、出生体重、手术时的日龄和体重、布洛芬疗程、RDS发生率、围术期呼吸机参数和生命体征、机械通气时间、氧疗时间、手术相关并发症和住院时间等临床资料进行分析。采用t检验、χ~2检验或Fisher精确概率法进行统计分析。结果 BPD组与无BPD组的出生时胎龄^([(29.3±2.1)与(30.7±1.6)周])和出生体重^([(1 050±190)与(1 220±140)g])比较,BPD组明显低于无BPD组(P值均<0.05),氧疗时间^([(36±14)与(27±13)天])和住院时间^([(73±22)与(53±19)天])比较,BPD组均明显长于无BPD组(P值均<0.05)。而手术时日龄和体重、布洛芬疗程、RDS发生率以及机械通气时间两组比较差异无统计学意义。BPD组的术前、术后24 h的吸入氧浓度均高于无BPD组^([0.46±0.13与0.33±0.11,0.43±0.12与0.32±0.13,P值均<0.05])。术前和术后的平均气道压及体温、脉搏和血压两组比较差异均无统计学意义。结论极早产儿的未成熟程度(胎龄和出生体重)及与此相关的围术期状态可能是导致PDA结扎术后发生BPD的重要因素;在NICU行床旁PDA结扎术安全可行。
Objective To study the relative factors on peri-operative status of patent ductus arteriosus(PDA)ligation and the bronchopulmonary dysplasia(BPD)in extremely preterm infants and to evaluate the safety of PDA ligation performing in the neonatal intensive care unit(NICU).Methods From May 2015 to April 2018,44 cases were admitted with birth weight<1,500 g and gestational age between 28 to 31+6 weeks and undergoing PDA ligation in the NICU of Bayi Children's Hospital.The infants were divided as BPD group(29 cases)and none BPD group(15 cases)according to their discharge diagnosis.The clinical data were analyzed on gestational age,birth weight,onset date and weight at surgery,ibuprofen therapy,incidence of RDS,perioperative ventilatory parameters and vital signs,duration of ventilation,total days of oxygen therapy,and surgery-related complications and hospital stays of the infants.The statistical analysis was carried out by t test,χ^2 test or Fisher exact probability methods.Results The BPD group were lower(all P<0.05)than the none BPD group in gestational age[(29.3±2.1)vs(30.7±1.6)weeks]and birth weight[(1 050±190)vs(1 220±140)g]significantly.The BPD group were longer(all P<0.05)than the none BPD group in durations of oxygen therapy[(36±14)vs(27±13)d]and the lengths of hospitalization[(73±22)vs(53±19)d].There were no significant differences in onset date and weight at surgery,time of ibuprofen therapy,incidence of RDS,duration on ventilation.The BPD group were higher(all P<0.05)than the none BPD group in fractions of inspired oxygen before and 24 hours after surgery[0.46±0.13 vs 0.33±0.11,0.43±0.12 vs 0.32±0.13].There were no significant differences in mean airway pressure,temperature,pulse and blood pressure on preoperative and postoperative between two groups.Conclusions The immature degree(gestational age and birth weight)of extremely premature infants and related to the perioperative state may be an important factor to cause occurrencing BPD after PDA ligation.PDA ligation is safe and feasible to perf
作者
张艳平
张珊
王自珍
孔祥永
封志纯
ZHANG Yan-ping;ZHANG Shan;WANG Zi-zhen;KONG Xiang-yong;FENG Zhi-chun(Newborn Care Center,Bayi Children’s Hospital,The Seventh Medical Center,General Hospital of PLA,Beijing 100700,China)
出处
《发育医学电子杂志》
2019年第1期27-31,共5页
Journal of Developmental Medicine (Electronic Version)
基金
国家自然科学基金(81471492)
关键词
动脉导管未闭
床旁结扎术
预后
极早产儿
Extremely preterm infants
Patent ductus arteriosus
Ligation
Bronchopulmonary dysplasia
