极低出生体重早产儿动脉导管未闭的治疗

Treatment of patent ductus arteriosus in very low birth weight preterm infants

目的探讨极低出生体重早产儿有临床表现的动脉导管未闭的治疗方法方法本研究为前瞻性队列研究。2008年1月1日至2010年12月31日间出生体重〈1500g的确诊有临床表现的动脉导管未闭早产儿78例，其中42例采用口服吲哚美辛治疗者作为治疗组。36例未治疗者为对照组。观察吲哚美辛的疗效、副作用以及对早产儿的近远期预后。结果治疗组及对照组在性别比例、胎龄、动脉导管直径、合并心力衰竭、败血症、新生儿呼吸窘迫综合征、脑室内出血的差异均无统计学意义（P均〉0．05）。治疗组治疗后动脉导管关闭33例，关闭率为78．6％，高于对照组，自发关闭9例，关闭率25．0％，差异有统计学意义（x2=22．39，P=0．000）。治疗组治疗前后的血肌酐、血小板差异无统计学意义（P均〉0．05）。治疗组较对照组有较少的脑室内出血发生比例（z=1．167，P=0．030）、较短的总用氧时间[分别为（8．0±5．5）d和（13．3±9．3）d，t=2．225，P=．032]及住院时间r（39．0±7．7）d和（43．6±10．6）d，t=2．229，P=0．029]，且支气管肺发育不良、坏死性小肠结肠炎的发生情况组间差异无统计学意义（P均〉0．05）。治疗组中有5例药物治疗失败后使用胸腔镜钳闭动脉导管，术后3例发生肺部感染，1例出现胸腔积液，无死亡及气胸发生。结论极低出生体重早产儿有临床表现的动脉导管未闭应积极干预，口服吲哚美辛可有效关闭动脉导管，胸腔镜钳闭动脉导管可作为药物治疗失败后的一种选择。

Objective To investigate the treatment of symptomatic patent ductus arteriosus （PDA） in very low birth weight preterm infants. Methods From January 1, 2008 to December 31, 2010, 78 very low birth weight preterm infants （birth weight% 1500 g） were diagnosed as symptomatic PDA. Among which, 42 cases administered orally with indomethacin （0.2 mg/kg, every 12 hrs for three times） were taken as treatment group, while five cases in this group who failed to indomethacin treatment were interrupted with video-assisted thoracoscopic surgery. And 36 cases who did not receive treatment for duetus arteriosus were taken as control group. The clinical outcomes, complications and prognosis of these patients were observed. Results There were no significant differences between the gentle percentage, gestational age, diameter of ductus arteriosus, rate of complicated with heart failure, sepsis, neonatal respiratory distress syndrome and intraventricular hemorrhage of two groups （P〉0.05, respectively）. The ductus arterious closed in 33 patients of treatment group （78.6%） and in nine patients of control group （25.0%）（x =22.39,P=0.000）. There were no significant differences in serum creatinine level and platelet count between before and after the treatment in treatment group（P〉0.05）. Comparecd with control group, the treatment group had lower incidence of intraventricular hemorrhage （z=1. 167, P= 0. 030）, shorter duration of oxygen therapy [（8.0±5.5） d vs （13.3±9.3） d, t=2.225, P 0.0321 and shorter hospital stay [（39. 0±7. 7） d vs （43.6±10.6） d, t=2. 229, P=0. 029]; while the incidence of bronchopulmonary dysplasia and neerotizing enterocolitis were similar （P〉0.05）. The five cases of PDA who received video assisted thoracoscopic surgery were successfully interrupted with no residual shunt left, while three of them had lung infections and one had pleural effusion, but no pneumothorax and infant deathassociated with surgery occurred. Conclusions Symptomatic PDA of very low birth weight preterm infants should be treated actively. Oral indomethacin was an effective and safe method to cure the PDA in these infants. Surgical ligation under video-assisted thoracoscopic surgery after failure of indomethacin treatment might be a good option.