危重早产儿动脉导管未闭的床旁外科治疗

Bedside surgical ligation of patent ductus arteriosus in premature infants

目的:总结内科药物治疗无效的早产儿动脉导管未闭(patent ductus arteriosus,PDA)床旁外科手术的经验。方法:回顾性分析2009年10月至2011年10月,43例层流病房行床旁动脉导管结扎(或钳夹)术的手术过程及术后转归进行总结。结果:接受床旁动脉导管结扎(或钳夹)术的手术的早产PDA患儿共43例,男性28例、女性15例,胎龄26～34 w,出生体质量0.75～2.31 kg,平均1.44 kg。其中低出生体质量22例、极低出生体质量18例、超低出生体质量3例。手术时患儿年龄为3～30 d,平均7.2 d,体质量和出生体质量无明显差别。43例中有39例使用异丁苯丙酸治疗失败,4例因伴有严重出血倾向未予异丁苯丙酸而直接手术治疗。39例药物治疗的患儿中,治疗前均未发现药物治疗禁忌,但在治疗过程中出现肺出血、颅内出血及坏死性小肠结肠炎等并发症或者无效,而改行外科手术。术前43例中40例使用呼吸机辅助治疗,术前呼吸机治疗时间最长29 d,其中8例病情突然恶化行急诊手术。术后1例出现喉返神经损伤,所有患儿无术中死亡、无术中大出血等并发症。4例(9%)术后不能脱离呼吸机而死亡,其余均痊愈出院。结论:经内科保守治疗无效或内科药物治疗禁忌的早产儿PDA,行床旁动脉导管外科结扎(或钳夹)术是治疗早产儿PDA的相对安全有效的方法。

Objective：To discuss the experience of bedside surgical treatment of patent ductus arterio- sus （PDA） by ligature or clip ligating for premature infants. Methods ： The clinical data of 25 bedside surgical surgical ligation of PDA from Oct. 2009 to Oct. 2011 were retrospectively analyzed. Results： In all these 43 cases, no death was during the surgical operations, recurrent laryngeal nerve was harmed in one case, 4 cases （9%） were died after operation because of respiratory failure, others recovered perfectly. Conclusion： The PDA can be adequately exposed by a limited left posterlateral thoracotomy. Premature ICU department could satisfy the requirement of anesthesia and surgical operation. Surgical ligation of PDA, either by ligature or clip, is a good option for premature infants with PDA. The key step after operation is to prevent infection.