极早和超早产儿动脉导管未闭外科治疗指征及早期结局

Surgical indications and early outcomes of patent ductus arteriosus in very and extremely preterm infants

目的探讨外科治疗动脉导管未闭(PDA)的预测因素,了解极早和超早产儿PDA外科治疗者的住院结局。方法收集151例诊断为PDA的极早和超早产儿临床资料,根据治疗方式分为手术组和非手术组,比较2组临床资料,采用logistic多元回归分析明确外科治疗PDA的预测因素。结果手术组胎龄、出生体质量及最低舒张压明显降低;肺表面活性物质、布洛芬、利尿剂、正性肌力药应用率、心胸比及重度支气管肺发育不良(BPD)和早产儿视网膜病(ROP)发生率升高。手术组动脉导管直径、导管直径/体质量及左房内径/主动脉根部内径(LA/Ao)增加,导管处分流速度减慢。多因素logistic回归分析结果显示,动脉导管直径/体质量及最低舒张压是极早和超早产儿外科治疗PDA的预测因素。结论动脉导管直径/体质量>2.5 mm/kg和最低舒张压<24 mmHg增加了极早和超早产儿PDA外科治疗的可能性,外科治疗未增加并发症的发生率。

Objective To explore the indications of patent ductus arteriosus(PDA) ligation and to understand the hospitalization outcome of surgical treatment of PDA in very and extremely preterm infants(VPIs and EPIs). Methods A total of 151 children with PDA were divided into two groups:an operation group and a control group. The clinical data of the two groups were compared. Logistic multiple regression analysis was used to determine the predictive factors of surgical treatment of patients with PDA. Results The gestational age,birth weight,and minimum diastolic blood pressure in the operation group were significantly lower than those in the control group. The proportion of the application rate of pulmonary surfactant,ibuprofen,preoperative diuretics,positive inotropic drugs,the maximum cardiothoracic ratio,and the incidence of severe bronchopulmonary dysplasia and retinopathy of prematurity were significantly higher in the operation group than those in the control group. In the operation group,the diameter of arterial catheter,catheter diameter/weight ratio,and left atrial/aortic root ratio in the operation group were significantly larger,and the shunt speed at the catheter was significantly lower. Multivariate logistic regression analysis showed that a catheter diameter/body weight of greater than 2.5 mm/kg and a minimum diastolic blood pressure lower than 24 mmHg could be predictive of surgical treatment. Conclusion Arterial catheter diameter/weight of >2.5 mm/kg and minimum diastolic pressure of <24 mmHg can increase the likelihood that VPIs and EPIs will have to undergo PDA surgical treatment. Surgical treatment can effectively improve the cardiopulmonary function without increasing the incidence of complications.