前列腺素E1抢救导管依赖型先天性心脏病新生儿最小剂量的研究

Minimum dose study of prostaglandin E1 rescue neonates with catheter-dependent congenital heart disease

目的 评估动脉导管依赖型先天性心脏病新生儿在行介入性心导管术或开放性手术前应用前列腺素E1（PGE1）的最小有效剂量.方法 本研究为回顾性研究,选取在我院治疗的动脉导管依赖型先天性心脏病新生儿148例,所有患儿因动脉导管闭合后发生重大心脏缺损而面临疾病恶化的风险,动脉血氧饱和度（SaO2）〈75%.立即输注PGE1,剂量（0.003~0.010）μg/（kg·min）,并记录患儿PGE1治疗的剂量（包括开始剂量与最低剂量）.根据动脉导管对肺循环和全身循环的支持程度,将患儿分为肺血流量不足和（或）心脏血液混合不足患儿组（组1）与全身血流量不足患儿组（组2）,比较两组患儿应用PGE1的剂量与临床指标.根据动脉导管形态,将患儿分为A组（室间隔完整的完全性大动脉转位组）,B组（依赖动脉导管供应肺部血流组）,C组（依赖动脉导管供应主动脉血流组）,比较三组患儿应用PGE1剂量与临床指标.采用 Spearman相关分析评估与PGE1剂量相关因素.结果 患儿应用PGE1最低剂量为（0.002~0.005）μg/（kg·min）,平均最低剂量（0.0045±0.0004）μg/（kg·min）.两组PGE1治疗时间比较差异无统计学意义（P=0.968）.与组1比较,组2患儿治疗的开始剂量和最低剂量显著提高（P分别为0.022与0.007）;根据动脉导管作用不同与B、C组比较,A组年龄显著降低（P=0.002）;与A、C组比较,B组体质量显著降低（P=0.002）;与A、B组比较,C组SaO2显著提高（P=0.033）,开始剂量显著提高（P=0.029）,最低剂量显著提高（P=0.030）.患儿年龄与PGE1的初始剂量呈正相关,患儿SaO2与PGE1的初始剂量和最低剂量呈负相关.结论 低剂量PGE1治疗可以维持导管依赖型先天性心脏病患儿的导管通畅性.与肺动脉血流不足和心内血流混合不足的患儿相比,全身性血流不足的患儿需要输入较高剂量的PGE1.

Objective To evaluate the minimum effective dose of prostaglandin E1 （PGE1） in neonates with ductal-dependent congenital heart disease before interventional open cardiac surgery or open heart surgery.Methods This study was retrospective 148 children with ductal-dependent congenial heart disease treated in our hospital were included.All children were at risk of worsening clinical symptoms because of a significant cardiac defect after patient ductus arteriosus closure.The children were immediately injected with PGE1 at a dose of （0.003~0.010） μg/（kg·min） when their SaO2〈75%.The does of PGE1 was then continuously and regularly measured and recorded, including start dose and minimum dose according to the degree of support of the arterial catheters to the pulmonary circulation and systemic circulation.The children were divided into two groups： the children with pulmonary blood flow insufficiency and/or heart and blood hypoventilation（group 1） and the children with systemic blood flow insufficiency（group 2）.PGE1 dose and clinical characteristics were compared between the two groups.The children were divided into group A（complete transposition of the great arteries group）, group B（pulmonory flow insufficiency group）,group C（systemic flow insufficiency group）according to the shape of the ductus arteriosus.PGE1 does and clinical characteristics were compared between the tree groups.Spearman correlation analysis was used to assess the PGE1-related factors.Results The minimal dose of PGE1 was （0.002~0.050） μg/（kg·min） and the average minimal dose was （0.0045±0.0004） μg/（kg·min）.PGE1 treatment time between the two groups were not statistically significant（P=0.968）.The difference between the starting dose, and minimum dose of group 2 was statistically significant（P=0.022 and 0.007 maintenance dose respectively）.The age of the children was positively correlated with the initial measurement of PGE1.There was a positive correlation between blood oxygen saturation and the start dose of PGE1 and the lowest dose of maintenance dose.Conclusion Low-dose PGE1 can maintain the patency of catheter-dependent congenital heart disease.The children with systemic flow insufficiency need to have a higher dose of PGE1 compared with patients the children with complete transposition of the great arteries and pulmonary flow insufficiency group.