超早产儿有血流动力学意义的动脉导管未闭危险因素分析

Risk factors of hemodynamically significant patent ductus arteriosus in extremely preterm infants

目的探讨超早产儿有血流动力学意义的动脉导管未闭(hemodynamically significant PDA,hsPDA)的危险因素。方法选择2017年7月至2020年4月南京医科大学附属儿童医院新生儿医疗中心收治的超早产儿(胎龄<28周)进行回顾性分析,按照有无hsPDA分为hsPDA组和无hsPDA组,计算2组患儿生后3 d内的累计液体超负荷水平(fluid overload,FO),采用单因素及多因素分析探讨超早产儿发生hsPDA的危险因素。结果共纳入79例超早产儿,胎龄(27.0±0.9)周,出生体重(987±173)g,无hsPDA组23例,hsPDA组56例。单因素分析显示,血小板减少症(P=0.044)、需要肺表面活性物质(pulmonary surfactant,PS)治疗的新生儿呼吸窘迫综合征(respiratory distress syndrome,RDS)(P=0.006)及高FO水平(P=0.002)与超早产儿hsPDA有关;多因素分析提示需要PS治疗的RDS(OR=5.933,95%CI 1.360~25.883,P=0.018)及高FO水平(OR=1.261,95%CI 1.063~1.496,P=0.008)是超早产儿发生hsPDA的独立危险因素。受试者工作特征曲线分析提示FO区分有无hsPDA的截断值为-0.2%(敏感度、特异度分别为85.7%、56.5%,受试者工作特征曲线下面积=0.712,约登指数=0.422)。结论需要PS治疗的RDS及生后3 d内高FO水平是超早产儿发生hsPDA的独立危险因素。需要PS治疗的RDS患儿在给予PS后应及时监测血流动力学变化。超早产儿早期液体管理中,应严格监测FO水平,个体化输液,避免过高的FO水平。

Objective To study the risk factors of hemodynamically significant patent ductus arteriosus(hsPDA)in extremely preterm infants(EPI).Method From July 2017 to April 2020,EPI(gestational age<28 weeks)admitted to the Department of Neonatology of our hospital were included and analyzed retrospectively.According to whether hsPDA existed or not,the infants were assigned into non-hsPDA group and hsPDA group.Demographic findings and possible risk factors of hsPDA were collected.The cumulative fluid overload(FO)within 3 days after birth was calculated.Univariate and multivariate analysis were used to determine the risk factors of hsPDA.Result A total of 79 infants with gestational age of(27.0±0.9)weeks and birth weight of(987±173)g were enrolled,including 23 cases in non-hsPDA group and 56 cases in hsPDA group.Univariate analysis showed that thrombocytopenia(P=0.044),respiratory distress syndrome(RDS)treated with pulmonary surfactant(PS)(P=0.006)and high FO level(P=0.002)were associated with hsPDA.Multivariate analysis showed that RDS treated with PS(OR=5.933,95%CI 1.360~25.883,P=0.018)and high FO level(OR=1.261,95%CI 1.063~1.496,P=0.008)were independent risk factors for hsPDA in EPIs.ROC curve analysis showed that the cut-off value of FO was-0.2%,with 85.7%sensitivity and 56.5%specificity distinguishing the presence of hsPDA(AUC=0.712,Youden index=0.422).Conclusion High level of FO within the first 3 days of life and RDS treated with PS are independent risk factors for hsPDA in EPI.After PS treatment,hemodynamic changes of infants with RDS should be monitored closely.During early fluid management of EPI,FO should be strictly monitored to avoid high FO level.