早产儿和足月儿动脉导管闭合时间的研究

A study of the closure time of ductus arteriosus in premature and full-time infants

目的分析不同胎龄早产儿和足月儿动脉导管自然闭合时间及其对血压(BP)、外周血管阻力指数(SVRI)和心脏指数(CI)变化的影响。方法将2018年1月至2018年10月于温州市人民医院产科分娩的80例新生儿作为研究对象,根据新生儿胎龄的不同,其中胎龄<32周为早期早产儿组(23例),胎龄32~33+6周为中期早产儿组(21例),胎龄34~36+6周为晚期早产儿组(19例),胎龄≥37周为足月儿组(17例)。比较各组新生儿不同时间动脉导管自然闭合率,并比较各组新生儿在动脉导管关闭前后BP、SVRI及CI变化的差异。结果各组新生儿不同时间动脉导管自然闭合率的比较,存在明显差异(χ^2值分别为30.35、15.29、18.81、11.98、21.21,均P<0.05)。各组新生儿动脉导管关闭后收缩压(SBP)和舒张压(DBP)较关闭前均明显升高(P<0.05),各组新生儿动脉导管关闭前、关闭后SBP和DBP的组间比较,存在明显差异(F值分别为56.07、46.87、8.09、85.09,均P<0.05)。各组新生儿动脉导管关闭后SVRI较关闭前明显升高(P<0.05),且各组SVRI的组间比较,存在明显差异(F值分别为35.97、9.05,均P<0.05)。早、中、晚期早产儿组动脉导管关闭后CI较关闭前明显下降(P<0.05),而足月儿组动脉导管关闭后CI与关闭前比较,并无明显差异(F值分别为4.98、6.06,均P>0.05)。结论随着胎龄的增加,在出生早期(≥24h)动脉导管自然闭合率升高,且不同胎龄的早产儿与足月儿动脉导管关闭后血流动力学及血压波动明显,对早产儿应及时应用超声心动图与超声心排出量监测仪以尽早发现并对动脉导管未闭合者进行治疗。

Objective To analyze the natural closure time of ductus arteriosus in premature and full-term infants of different gestational ages and its effects on blood pressure(BP),systemic vascular resistance index(SVRI) and cardiac index(CI).Methods 80 neonates delivering in the department of obstetrics in Wenzhou People’s Hospital from January 2018 to October 2018 were collected.According to the different gestational age,all 80 subjects were divided into four groups,including the group of early premature infants with gestational age<32 weeks(23 cases),the group of medium-term premature infants with gestational age of 32-33+6(21 cases),the group of late premature infants with gestational age of 34-36+6(19 cases),and the group of full-term infants with gestational age ≥37 weeks(17 cases).And then we compared the difference of natural closure rate of ductus arteriosus at different time in each group and the changes of BP,SVRI and CI before and after ductus arteriosus closure in each group.Results Significant differences were found in the natural closure rate of ductus arteriosus between groups at different time(χ^2 values were 30.35,15.29,18.81,11.98 and 21.21,respectively,all P<0.05).Systolic blood pressure(SBP) and diastolic blood pressure(DBP) of neonates after closure of ductus arteriosus in each group were significantly higher than before closure(P<0.05).There were significant differences among four groups in SBP and DBP before and after arterial catheter closure(F values were 56.07,46.87,8.09 and 85.09,respectively,all P<0.05).The SVRI of neonates after closure of ductus arteriosus was significantly higher than before closure(P<0.05),and there was a significant difference among four groups(F values were 35.97 and 9.05,respectively,all P<0.05).CI in early,middle and late preterm infants after closure of ductus arteriosus were significantly lower than before closure(P<0.05),but CI in full-term infants after closure of ductus arteriosus showed no significant difference with before closure(F values were 4.98 and 6.06,respectively,all P>0.05).Conclusion With the increase of gestational age,the natural closure rate of ductus arteriosus might increase at the early stage of birth(≥24 hours),and the hemodynamics and blood pressure fluctuations are obvious after the closure of ductus arteriosus in early and full-term infants of different gestational ages.Therefore,echocardiography and echocardiographic cardiac output monitor should be applied for premature infants to detect and treat the unclosed ductus arteriosus as soon as possible.