早产儿动脉导管自然关闭时间及其影响因素  

Time and risk factors for spontaneous closure of patent ductus arteriosus in preterm infants

作　　者：吴本清[1] 唐其柱[1] 闰玉琴[2] 燕旭东[2] 

机构地区：[1]武汉大学人民医院心血管专业,430060 [2]深圳市人民医院新生儿科,430060

出　　处：《中华围产医学杂志》2012年第3期140-146,共7页Chinese Journal of Perinatal Medicine

摘　　要：目的观察早产儿生后1周内动脉导管功能性自然关闭的时间及其影响因素2方法177例动脉导管开放的早产儿根据胎龄分为28-31＋6、32-34＋6和35-36＋6周组，各组分别为44、59和74例2所有研究对象按8个时间段以超声心动图监测动脉导管关闭情况及心功能变化，分别为≤12h、-24h、-48h、-72h、-96h、-120h、-144h、〉144但≤168h2心功能测量指标包括左心室射血分数、每搏输出量、心搏出量、主动脉瓣口峰流速、肺动脉瓣口峰流速以及二尖瓣口、三尖瓣口的舒张早期峰流速和舒张晚期峰流速比值2对影响动脉导管自然关闭时间的因素进行Logistic多因素分析2结果28-31＋6、32-34＋6和35-36＋6周3组生后1周动脉导管累积自然关闭率分别为95．5％、100．0％和100．0％，3组不同时间段动脉导管累积关闭率比较，差异有统计学意义（y2值分别为4．23、7．45、12．46、7．14、4．75、6．47、3．89、3．89，P均〈0．05）2生后12-24h动脉导管自然关闭者，动脉导管关闭后肺动脉瓣口峰流速较关闭前增快[（O．69±0．12）cm／s与（0．65±0．12）cm／s，t-2．37，P-0．02]，主动脉瓣口峰流速较动脉导管关闭前减慢[（0．65±0．11）cm／s与（0．69±0．12）cm／s，t-2．51，P-0．02]，左心室射血分数较关闭前降低[（63．00±8．50）％与（66．00±8．50）％，f-2．34，P=0．02]2Logistic回归分析显示，影响早产儿动脉导管生后12-24h未闭的独立危险因素为胎龄（OR-1．825，95％CI：1．239-2．689）、1minApgar评分0-3分（OR-1．946，95％CI：1．572-3．527）和早发型败血症（OR-3．215，95％CI：1．245-5．463）；24-48h未闭的独立危险因素为胎龄（OR-3．270，95％C1：1．852-5．774）、双胎（OR-3．634，95％C1：1．489-8．871）、lrainApgar评分0-3分（OR-3．752，95％CI：2．156-5．436）、呼吸窘迫综合征Ⅲ-Ⅳ期（OR-2．897，95％CI：1．764-5．348）和早�Objective To investigate the time and risk factors for spontaneous closure of patent ductus arteriosus （PDA） in preterm infants. Methods One hundred and seventy seven preterm infants with arterial ductus unclosed were divided into three groups according to their gestational age as 28-31＋6 weeks group （n-44）, 32 34＋6 weeks group （n=59） and 35-36＋6 weeks group （n：74）. PDA was diagnosed by eehocardiography in time of 412 h, -24 h, -48 h, 72 h, 96 h, 120 h,-144 h and 〉144 but 4168 h after birth. The parameters of cardiac function included peak flow rate of aorta valve orifice, peak flow rate of pulmonary artery valve orifice, cardiac output, stroke volume, ejectionfraction, the ratio of early （E） and late （A） diastolic velocities of mitral and tricuspid valves. The risk factors of arterial ductus spontaneous closure were determined by Logistic regression analysis. Results The cumulative spontaneous closure rates of preterm infants in three groups were 95.5%, 100.0% and 100.0% within 168 h after birth respectively. There were significant differences of cumulative spontaneous closure rate in different time among three groups （Z2=4.23, 7.45, 12.46, 7.14, 4.75, 6.47, 3.89 and 3.89 respectively, P〈0.05）. After spontaneous closure of PDA during 12-24 h, peak flow rate of pulmonary artery valve orifice increased [（0.69_＋0.12） cm/s vs （0.65＋0. 12） cm/s, t=2.37, P-0.02], peak flow rate of aorta valve orifice [（0.65±0.11） cm/s vs （0.69±0.12） cm/s, t-2.51, P=0.021 and ejection fraction [-（63.00±8.50） % vs （66.00% 8.50） %, t= 2.34, P 0. 021 decreased. Logistic regression analysis showed that, the risk factors of preterm infants with arterial ductus unclosed within 24 hours after birth were gestation age （OR 1.825, 95%CI： 1.239-2.689）, 1 min Apgar score 0-3 （OR 1.946, 95%CI： 1.572-3.527） and early onset sepsis （OR=3. 215, 95%CI： 1. 245-5. 463） ; gestation age （OR=3. 270, 95%CI： 1. 852 5. 774）, twins （OR%3. 634, 95%0CI.. 1. 489 8. 871�

关 键 词：动脉导管未闭 婴儿 早产 时间 心室功能 左 

分 类 号：R722.6[医药卫生—儿科]