不同治疗方式对早产儿动脉导管未闭的疗效及安全性评价

Evaluation of therapeutic effects and safety of different treatment methods for premature patent ductus arteriosus

摘要:

目的 探讨早产儿动脉导管未闭(PDA)的临床治疗方式及效果,总结手术治疗PDA 的经验。方法 2013 年1 月至2014 年12 月诊断为PDA 并行手术治疗的早产儿19 例为手术组,同期未行手术治疗的19 例PDA 早产儿为非手术组。分析两组在病史因素、临床因素、病死率及主要并发症等方面的差异,同时从术前准备及手术结果方面分析手术治疗的特点及临床效果。结果 非手术组早产儿胎龄及出生体重均大于手术组(P<0.01),且生后1 min 及5 min Apgar 评分均高于手术组(P<0.05);手术组患儿PDA 直径、超声确诊时间及辅助通气时间均大于非手术组,且药物治疗、左心房/主动脉根部(LA/AO)比值>1.3 及导管直径的平方/出生体重(d²/BW)比值>9 mm²/kg 的发生率均高于非手术组(P<0.05);手术组早产儿BPD 发生率高于非手术组(P<0.01);而死亡、脑白质损伤、颅内出血和NEC 发生率在两组间比较差异均无统计学意义(P>0.05)。结论 对有临床症状且内科保守治疗或药物治疗无好转的早产儿PDA,外科结扎术是相对安全有效的方法。

Abstract:

Objective To explore the clinical treatment methods and their effects in the treatment of premature patent ductus arteriosus (PDA) and to summarize the experience of surgical treatment for PDA. Methods Nineteen premature infants who were diagnosed with PDA and received surgical treatment betwen January 2013 and December 2014 were selected as the surgical group, and 19 premature infants with PDA who did not receive surgical treatment during the same period were selected as the non-surgical group. The differences in medical history, clinical conditions, mortality, and major complications between the two groups were analyzed, and the characteristics of surgical treatment and its clinical effects were analyzed from the aspects of preoperative preparation and surgical results. Results Compared with the surgical group, the gestational age and birth weight in the non-surgical group were significantly greater (P<0.01), and Apgar scores for 1 and 5 minutes after birth were significantly higher in the non-surgical group (P<0.05). The PDA diameter, time to confirmed ultrasonic diagnosis, and duration of auxiliary ventilation in the surgical group were greater than in the non-surgical group, and the incidence of drug therapy, left atrium/aortic root (LA/AO) ratio >1.3, and the square of catheter diameter/birth weight (d²/BW) ratio >9 mm²/kg in the surgical group was significantly higher than in the non-surgical group (P<0.05). Compared with the non-surgical group, the surgical group had a significantly higher incidence of bronchopulmonary dysplasia (P<0.01), and there were no significant differences in the incidence of death, cerebral white matter damage, intracranial hemorrhage, and necrotizing enterocolitis between the two groups (P>0.05). Conclusions For premature infants with clinical symptoms and no improvement after conservative medical treatment or drug therapy, surgical ligation is a relatively safe and effective treatment method for PDA.