有血流动力学意义的动脉导管未闭早产儿布洛芬治疗失败的危险因素分析

Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus

摘要:

目的 研究有血流动力学意义的动脉导管未闭（hemodynamically significant patent ductus arteriosus, hsPDA）早产儿布洛芬治疗失败的高危因素。方法 回顾性收集华中科技大学同济医学院附属湖北妇幼保健院新生儿科2018年1月—2023年6月收治的胎龄<34周hsPDA早产儿的临床资料，根据治疗方式的不同分为布洛芬组（95例）和布洛芬+手术组（44例），采用二元logistic回归分析探讨hsPDA早产儿布洛芬治疗失败的高危因素。结果 二元logistic回归分析显示，动脉导管直径增大、大脑中动脉阻力指数（resistance index, RI）值≥0.80、总有创机械通气时间延长是hsPDA早产儿布洛芬治疗失败的高危因素（P<0.05）。受试者操作特征曲线分析显示，动脉导管直径>2.85 mm，大脑中动脉RI值≥0.80，总有创机械通气时间>16 d对hsPDA早产儿布洛芬治疗失败具有预测价值（P<0.05）；三者联合预测价值最高，曲线下面积为0.843，灵敏度为86.5%，特异度75.0%（P<0.05）。结论 动脉导管直径>2.85 mm、大脑中动脉RI值≥0.80、总有创机械通气时间>16 d是hsPDA早产儿布洛芬治疗失败的高危因素，并对临床上布洛芬治疗失败需手术治疗具有重要参考意义。

Abstract:

Objective To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA).Methods A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis.Results The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05).Conclusions A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.