摘要
目的 探讨无创心输出量参数监测指导早产儿动脉导管未闭（patent ductus arteriosus,PDA）药物治疗的价值.方法 前瞻性选择2016年2～8月我院新生儿重症监护病房收治的胎龄28 ～ 31周或出生体重1 000～1 799 gPDA早产儿,监测无创心输出量参数心脏指数（cardiac index,CI）和射血分钟距离（minute distance,MD）,并以主动脉CI≥2.95 L/（min·m^2）、MD≥21.50 m/min,同时肺动脉CI≥4.55 L/（min·m^2）、MD≥26.50 m/min为界值将PDA早产几分为PDA需处理组和PDA不需处理组,采用t检验、x2检验进行统计学分析,比较两组动脉导管关闭率、需处理组动脉导管关闭前后无创心输出量参数变化.结果 共纳入需处理组24例,不需处理组43组,动脉导管总体关闭率为85.1％ （57/67）,需处理组关闭率低于不需处理组（70.8％比93.0％）,差异有统计学意义（P＜0.05）.动脉导管关闭后肺动脉流动时间、主动脉每搏输出指数、速度时间积分均明显低于关闭前[（217.6±19.3） ms比（235.8 ±21.4） ms,（22.4±6.0） ml/m2比（25.2±7.7） ml/m2,（15.1±4.1） cm比（17.2±5.3） cm],差异有统计学意义（P＜0.05）;关闭后主、肺动脉CI、MD有所下降,但与关闭前比较差异无统计学意义（P＞0.05）.结论 无创心输出量参数主、肺动脉CI、MD对于早产儿PDA药物治疗具有一定指导意义;PDA药物治疗后不能单纯根据主肺动脉CI、MD变化判断动脉导管关闭情况,仍需结合超声心动图检查结果.
Objective To evaluate the value of monitoring non-invasive cardiac output parameters in medical treatment of patent ductus arteriosus （PDA） in premature infants.Method Premature infants with PDA diagnosed three days after birth （gestational age：28 ～ 31 weeks or birth weight of 1 000 ～ 1 799 g） admitted to the neonatal intensive care unit （NICU） of our Hospital from February 2016 to August 2016 were enrolled in the study.These premature infants were assigned into treated PDA group （the treatment group） and untreated PDA group （the observation group） based on results of non-invasive cardiac output parameters CI and MD,with aorta CI ≥2.95 L/（min · m2）,MD ≥21.50 m/min and pulmonary artery CI ≥4.55 L/（min · m2）,MD ≥26.50 m/min as cut-off values.Statistical analysis was carried out using t test,x2 test.The closure rate of arterial duct of two groups and changes in non-invasive cardiac output parameters before and after the closure of arterial duct in the treatment group were compared.Result The overall closure rate of arterial duct was 85.1% （57/67）.The closure rate of arterial duct of the treatment group was 70.8% （17/24）,that of the observation group was 93.0% （40/43）,and the difference had statistical significance （P 〈 0.05）;Comparing the following parameters before and after ductal closure in the treatment group,the difference of pulmonary artery flow time （FT）,aorta stroke volume index （SVI） and the integral of the flow profile （Vti） had statistical significance （P 〈 0.05） [（217.6±19.3） ms vs.（235.8 ±21.4） ms,（22.4±6.0）ml/m2 vs.（25.2 ±7.7）ml/m2,（15.1 ± 4.1） cm vs.（17.2 ±5.3） cm].In the treatment group,after arterial duct was closed,aorta and pulmonary artery CI,MD decreased to some degree,but the difference had no statistical significance （P 〉 0.05）.Conclusion Non-invasive cardiac output parameters including aorta and pulmonary artery CI,MD have certain guiding significance for PDA drug treatment among premature infants;after PDA drug treatment,arterial duct closure condition cannot be judged simply by the changes of aorta and pulmonary artery CI,MD,ultrasonic cardiogram examination results should also be considered
