早产儿动脉导管未闭介入封堵术一例并文献复习

Transcatheter occlusion of patent ductus arteriosus in a preterm infant and review of literatures

目的总结血液动力学显著异常的早产儿动脉导管未闭（hsPDA）的特点及经导管介入封堵术的适应证。方法报道四川大学华西第二医院2013年12月收治的1例早产儿PDA经导管介入封堵术的病例资料，以“preterm”“patentductusarteriosus”“transcatheter”为关键词，经Pubmed检索并进行文献复习。结果患儿女，双胎之小，胎龄35周，剖宫产娩出，出生体重1900g，出生后1min、5min、10minApgar评分均为10分，出生后入新生儿重症监护病房治疗；口服布洛芬未能关闭其动脉导管，表现出“呼吸机依赖PDA”的特点；患儿出生后第30天（体重1950g）在基础麻醉状态下成功实施经导管PDA介入封堵术，所用封堵器为Amplatzerductoccluder（ADO）；患儿术后19h撤离呼吸机，术后7d出院，恢复良好。随访至13月龄，Bayley婴幼儿发育量表显示患儿智力及体格发育处于正常同龄儿童相同水平。纳人2005至2015年8篇相关文献的52例早产儿PDA介入封堵术病例，患儿出生胎龄23～35周，PDA直径1～4mm，介入封堵术所用封堵装置分别为Coil、ADO、ADOⅡ、ADOⅡAS、AVPⅡ和AVPⅣ，术时体重870—2610g，术时年龄出生后11—90d，均为药物治疗失败或药物治疗禁忌的hsPDA病例，介入封堵术均成功实施；无严重手术相关并发症发生。结论早产儿PDA经导管介入封堵术指征为药物治疗失败或药物治疗禁忌的hsPDA，近期及远期疗效确切。

Objective To investigate the characteristics of haemodynamically significant patent ductus arteriosus （ hsPDA）, and the indications of percutaneous transcatheter PDA occlusion. Method The data of a preterm infant admitted to West China Second Hospital in December. 2013, who finally underwent percutaneous transcatheter PDA occlusion were analyzed With the key words of ＂preterm＂ ＂patent ductus arteriosus＂ ＂ transcatheter＂, Pubmed were searched and potentially relevant reports were retrieved and assessed by manual sorting from 2005 to 2015. Relevant reports in literature were reviewed. Result A preterm irffnat at gestational age of 35 weeks with birth weight of 1 900 g was admitted to our department. Oral ibuprofen for closure of the patent ductus arteriosus failed, and the patient exhibited the features of ＂ ventilator dependent＂ PDA of premature infants. On the 30th postnatal day, with the body weight of 1 950 g, under basal anesthesia, the infant underwent percutaneous transcatheter PDA occlusion, and the procedure successfully occluded the ductus with Amplatzer duct occluder （ADO）. The ventilator was weaned 19 hours post procedure, and the child was discharged 7 days post operation with good recovery, and her growth and development was good. Follow-up for 13 months indicated that the intelligence and physical development evaluated by Bayley scales of infant development test were at the same level of normal age- matched infants. Fifty-two preterm infants treated with percutaneous transcatheter PDA occlusion in 8 reports were enrolled. The preterrn infants were born at 23 - 35 gestational weeks, with PDA diameter of 1 - 4 mm. The occlusive device included coil, ADO, ADO Ⅱ , ADO Ⅱ AS, AVP Ⅱ and AVP Ⅳ respectively, with body weight of 870 -2 610 g on operational days and age of 11 -90 postnatal days. All those infants either failed or had contraindications to drug therapy, and exhibited as hsPDA cases. Percutaneous transcatheter PDA occlusions were performed successfully in all 52 cases, and there were no serious procedure-related complications. Conclusion Percutaneous transcatheter PDA occlusion in preterm infants is feasible and showed positive short-term and long-term effects, which provides an important alternative way for patients with the problem. The indications for transcatheter PDA occlusion include premature infants with hsPDA in whom drug therapy failed or is contraindicated.