超低、极低出生体重未成熟新生儿动脉导管未闭手术体会

Operation experienles of patent Ductus Arterionus for hight ultralow birth newborn

目的探讨超低、极低出生体重未成熟新生儿动脉导管未闭结扎手术的指针、时机和方法。方法对3例超低、6例极低出生体重未成熟新生儿动脉导管未闭,经过呼吸机辅助呼吸等内科保守治疗,呼吸困难等症状未见改善的情况下,行在气管插管全麻下行未闭动脉导管结扎术。该组病例手术均顺利完成,4例是采取的常规结扎、2例是采取4/0的prolenes线缝扎、3例是钛夹钳夹闭。结果 3例超低出生体重未成熟新生儿,动脉导管未闭结扎术后,有1例术后11天因为合并多器官功能不全死亡;6例极低出生体重未成熟新生儿,动脉导管未闭结扎术后,有1例术后合并有乳糜胸经引流后治愈,其它术后顺利。结论超低、极低出生体重未成熟新生儿动脉导管未闭,经内科保守治疗未见好转,在没有明显禁忌症存在的情况下,应该尽早行动脉导管结扎术。

Objective To investigate the pointer, opportunity and methods of ligation of patent ductus arteriosus in VL- BW/ELBW premature infants. Methods We selected 3 cases of VLBW and 6 cases of ELBW premature infants with patent ductus arteriosus whose dyspnea did not improved with the help of mechanical ventilation and other conservative treatments to be ligated in general anesthesia, and all surgeries were completed successfully. 4 cases were taken by conventional ligation, 2 cases were sutured by prolenes with size 4/0, and 3 cases were clipped with titanium clamps. Results 1 case in three of ELWB premature infants died of multiple organ failure in 11 days after surgery. One case of VLWB premature infants suffered chylotho- rax was cured by drainage, others recovered well after surgery. Conclusion The VLBW/ELBW premature infants with patent ductus arteriosus should operate as soon as possible if the situation did not improve after conservative treatment and without the exist of obvious contraindications.