床旁结扎手术治疗16例足月新生儿动脉导管未闭的临床分析

Clinical analysis on bedside ligation closure of patent ductus arteriosus in 16 term newborns

目的研究需要手术结扎的足月新生儿动脉导管未闭(PDA)的临床特点。方法对本院足月新生儿病房需呼吸机支持治疗的、布洛芬药物治疗无效的16例PDA患儿行床旁结扎手术治疗前后的临床表现、辅助检查、内环境指标、炎性指标、生化改变进行回顾性分析。结果所有患儿手术前均有呼吸困难、活动后呼吸急促、青紫、三凹征阳性,心前区杂音,双肺均可闻及湿啰音,7例肝脏增大超过肋下3 cm,双下肢水肿有3例;术前X线胸片:双肺肺血增多,肺纹理增多模糊,斑片状影。所有病例均有代谢性酸中毒、低蛋白血症(总蛋白、白蛋白、前白蛋白均降低);PDA内径:最小2.5 mm,最大6.0 mm,平均(4.244±1.080)mm。PDA结扎时间在出生后(17.938±8.706)天;术前气管插管机械通气天数(10.125±6.087)天。行结扎术后患儿症状体征改善明显,术后3天X线胸片示肺血明显减少,术后上机(3.667±2.743)天,能顺利撤机。结论 PDA床旁结扎安全、有效,对于左向右分流较重、药物关闭无效的PDA,即使合并其他心脏畸形,手术关闭导管对于治疗充血性心力衰竭、防止发生肺血管病变、缩短机械通气时间是一种良好的选择。

Objective To study the clinical features of term infants who have patent ductus arteriosus (PDA) and need for surgical ligation. Method Retrospective analyses were performed before and after surgical bedside ligation treatment about the clinical manifestation, laboratory examinations, environmental indicators, inflammatory markers, and biochemical changes on 16 cases of PDA term newborns who required ventilator support and were ibuprofen medications ineffective in the neonatal intensive care. Result All patients had dyspnea, shortness of breath after activities, cyanoderma, three depressions positive, precordial murmur, and lungs moist rales. Liver increased over the ribs 3cm in seven cases of neonatal. 3 cases had edema of both legs. Preoperative chest X-ray radiograph showed an increase of pulmonary blood and, lung markings, as well as patchy shadow. All patients had metabolic acidosis and hypoproteinemia (total protein, albumin, and prealbumin all decreased). The average inside diameter of PDA was 4.244 ± 1.080 mm (2.5mm to 6.0mm). The time of the PDA ligation was 17.938 ± 8.706 days after birth; the average preoperative intubation and mechanical ventilation time was 10.125 ± 6.087 days. Signs and symptoms in postoperative children improved obviously. Pulmonary blood was significantly reduced in lung at 3 days after operation. The average postoperative ventilation was 3.667 ± 2.743 days. Conclusion Bedside ligation closure of PDA is safe and effective for left to right shunt heavier, drugs ineffective, even combined with other cardiac malformations. Surgical closure patent ductus arteriosus is a good choice for the treatment of congestive heart failure, to prevent the occurrence of pulmonary vascular disease, and to short the duration of mechanical ventilation.