极低出生体重儿动脉导管未闭转归的影响因素分析

Factors influencing the prognosis of patent ductus arteriosus in very low birth weight infants

摘要:

目的 分析极低出生体重儿动脉导管未闭 （PDA） 转归的影响因素。方法 以2012年1月至2014年12月收治的194例极低出生体重儿为研究对象，根据心脏超声检查及治疗转归情况分为无PDA组，PDA自然关闭组、药物关闭组、手术关闭组，分析其临床及超声心动图特征。结果 PDA自然关闭率58.7%。自然关闭组的出生胎龄、出生体重、小于胎龄儿比例均大于药物和手术关闭组，药物及手术关闭组的新生儿呼吸窘迫综合征发生率及肺表面活性物质 （PS） 应用比例高于自然关闭组 （P < 0.05）。不同时间段自然关闭组的动脉导管直径均明显小于药物和手术关闭组 （P < 0.05）。多因素logistic回归分析示出生胎龄、PS应用及48h动脉导管直径与PDA转归显著相关。自然关闭组PDA分流类型均以关闭型为主，而药物及手术关闭组在48h以肺高压型及进展型为主，在4d、7d时均以进展型为主。结论 极低出生体重儿PDA自然关闭率较高，出生胎龄越小以及应用PS的患儿自然关闭率越低；动脉导管直径越大且分流类型为进展型或脉冲型的PDA不易自然关闭。

Abstract:

Objective To investigate the factors influencing the prognosis of patent ductus arteriosus (PDA) in very low birth weight (VLBW) infants. Methods A total of 194 VLBW infants who were admitted from January 2012 to December 2014 were enrolled as study subjects. According to cardiac ultrasound findings and treatment outcome, these infants were divided into non-PDA group, spontaneous closure group, pharmaceutical closure group, and surgical closure group. Their clinical and echocardiographic characteristics were analyzed. Results The spontaneous closure rate of PDA was 58.7%. The spontaneous closure group showed significantly higher gestational age, birth weight, and proportion of small-for-gestational-age infants than the pharmaceutical and surgical closure groups (P < 0.05). The pharmaceutical and surgical closure groups had a significantly higher incidence rate of neonatal respiratory distress syndrome and a significantly higher proportion of infants who were given pulmonary surfactant (PS) than the spontaneous closure group (P < 0.05). During different periods of time, the spontaneous closure group had a significantly smaller ductus arteriosus diameter than the pharmaceutical and surgical closure groups (P < 0.05). The multivariate logistic regression analysis showed that gestational age, application of PS, and ductus arteriosus diameter at 48 hours were significantly associated with the prognosis of PDA. The major transductal flow pattern in the spontaneous closure group was closing pattern, while in the pharmaceutical and surgical closure groups, the main flow patterns were pulmonary hypertension and growing patterns within 48 hours and growing pattern on days 4 and 7. Conclusions The VLBW infants have a high spontaneous closure rate of PDA. A decreased closure rate of PDA is associated with the lower gestational age and the application of PS. PDA with a large ductus arteriosus diameter and a growing or pulsatile flow pattern cannot easily achieve spontaneous closure.