脂溶性前列地尔维持室间隔完整型大血管转位患儿动脉导管开放的疗效分析

Prostaglandin E1 used as a pre-operative treatment for the neonates with transposition of great vessels with intact ventricular septum

目的 分析脂溶性前列地尔术前维持窜间隔完整犁大血管转位（TGA/IVS）患儿动脉导管开放的疗效.方法 2004年1月至2009年6月浙江大学医学院附属儿童医院共收治TGA/IVS患儿34例,入院后立即经皮测定脉搏血氧饱和度（SpO2）,诊断明确后立即外周静脉持续泵入脂溶性前列地尔（Lipo-PGE1）维持动脉导管（DA）开放.记录Lipo-PGE1的剂量,起效时间;观察泵入前后SpO2变化;分析术前心脏多普勒超声测量和术中测定的DA直径大小差异.结果 Lipo-PGE1初始剂量均为5 ng/（kg·min）.3例患儿根据SpO2变化调整剂量,其中2例达10 ng/（kg·min）,1例高达15ng（kg·min）.起效时间5～15 min,（12±3）min.入院时患儿平均SpO2（80.05±7.64）%,术前2 h平均SpO2（86.41±4.83）%.入院时心脏多普勒超卢测量平均DA大小（0.37±0.08）cm,术中测最DA外径平均（0.51±0.15）cm.2例患儿出现小良反应,1例因呼吸暂停紧急气管插管辅助通气.结论 经外周静脉持续泵入5 ng/（kg·min）Lipo-PGE1能良好维持患儿动脉导管的开放,增加肺动脉血流,促进血液交换,改善缺氧,纠正酸中毒,为手术赢得准备时间.其副作用主要有呼吸暂停,外周血管扩张等,考虑与剂量有关.

Objective To study the therapeutic effects of prostaglandin E1 on the neonates with transposition of the great vessels with intact ventricular septum （TGV/IVS） retrospectively. Method From January 2004 to June 2009, 34 neonates with TGV/IVS were enrolled in this study. The pulse rate and oxygen saturation （SpO2） of patients were measured percutaneouly at admission. Lipo-prostaglandin E1 （Lipo-PGE1） was administered via peripheral vein with pumping infusion continuously after diagnosis by echocardiography in order to keep the ductus arteriosus （DA） patent. The dose and the time required for the Lipo-PGEl to produce effect were recorded. The changes of SpO2 before and after administration of Lipo-PGE1 were observed. The changes of DA＇s diameter detected by using echocardiography before and during the operation. Results In all patients the initial dose of Lipo-PGEl was 5 ng/（ kg·min） except 3 patients whom larger dosed were required to give guided by the change of SpO2 with 10 ng/（kg·min） in two patients and 15 ng/（kg·min） in one patient. The time required for Lipo-PGE to produce the effect was 5-15 minutes in most infants with mean of （12 ± 3） minutes. The mean SpO2 of the patients measured at admission was （80.05±7.64）%, and it was （86.41±4.83）% two hours before operation （P 〈 0.05）. The average diameter of DA was （0.37±0.08） cm at the time diagnosis and it was （0.51 ±0.15） cm during the operation. The adverse effects occurred in two patients and one of them had apnea and was treated mechanical ventilation. Conclusions Lipo-PGE1 given by continuous pumping infusion via peripheral vein in dose of 5 ng per kilogram per minute can maintainthe DA patency and promote the systemic oxygenation and perfusion, improving the circulation and oxygenation and correcting the acidosis until the plastic surgery performed. Most of the adverse effects of PGE1 are dose related.