早产儿动脉导管未闭的临床特点及其心脏血流动力学研究  

Clinical characteristics and cardiac hemodynamic changes of patent ductus ateriosus in preterm infants

作　　者：陆丹芳[1] 刘云峰[1] 童笑梅[1] 

机构地区：[1]北京大学第三医院儿科,100191

出　　处：《中华儿科杂志》2015年第3期187-193,共7页Chinese Journal of Pediatrics

基　　金：教育部博士点新教师基金（20120001120071）

摘　　要：目的 探讨早产儿动脉导管未闭（PDA）的临床特点及其对心脏血流动力学的影响.方法 入选2012年10月至2013年9月北京大学第三医院新生儿重症监护病房收治的出生胎龄≤34周、体重≤2 000 g的早产儿105例,其中男63例、女42例,出生胎龄（31.1±1.9）周,出生体重（1 401±314）g.均于生后第2、3、5、7天进行床旁超声心动图（UCG）检查,生后2～3d根据临床表现及UCG结果将患儿分为3组：有血流动力学意义的PDA（hsPDA）组34例,无血流动力学意义的PDA（nhsPDA）组44例,无PDA （nPDA）组27例.观察各组的一般情况、动脉导管内径、分流方向、评估左室功能及相关合并症.采用单因素分析或多因素Logistic回归分析比较各组差异.结果 hsPDA组胎龄明显小于nhsPDA组[（30.5±2.1）比（31.6±1.6）周,F=3.40,P=0.01],肺表面活性物质（PS）应用及生后2、3、5d的机械通气比例均显著高于nhsPDA组和nPDA组（x2 =11.62、14.95、12.73、11.59,P=0.00、0.00、0.01、0.01）.单因素和多因素Logistic回归分析示平均住院时间与hsPDA有相关性（F=3.52、P=0.03,OR=1.03,P=0.02）,hsPDA组的平均住院时间明显长于nhsPDA组和nPDA组[（39±23）比（30±16）和（29±13）d,P=0.02、0.03].hsPDA组死亡或放弃治疗患儿比例与其他两组比较差异无统计学意义[5.9％ （2/34）比0（0/44）和3.7％（1/27）,x2=5.26,P =0.06].早产儿在生后2、3、5d,hsPDA组的舒张压和平均压均显著低于nhsPDA组和nPDA组（P均＜0.05）,生后2 d hsPDA组脉压大于nPDA组（P=0.04）.单因素和多因素Logistic回归分析结果发现hsPDA与新生儿呼吸窘迫综合征（NRDS）、支气管肺发育不良（BPD）显著相关（x2=7.34、7.39,P=0.02、0.02;OR=3.46、4.01,P=0.04、0.02）.生后7d内hsPDA的存在使左室心输出量（CO）增加（F=6.93,P＜0.01）,而左室短轴缩短分数（FS）和左室射血分数（EF）无明显变化.生后第7天hsPDA组动脉导管关闭后与同时间nhObjective To study clinical characteristics and evaluate cardiac hemodynamic changes in premature infants with patent ductus ateriosus （PDA）.Method One hundred and five infants born at ≤ 34 weeks＆#39; gestational age （GA） and ≤2 000 g birth weight （BW） were prospectively enrolled,including 63 males and 42 females,and the mean GA was （31.1 ± 1.9） weeks and BW （1 401 ± 314） g.Echocardiography was done to detect hemodynamically significant PDA （hsPDA） and to evaluate left ventricular function at 2,3,5 and 7 d respectively after birth.On the basis of clinical symptoms and echocardiographic outcome,all the cases were divided into 3 groups：hsPDA group （n =34）,non-hsPDA （nhsPDA） group （n =44） and non-PDA （nPDA） group （n =27） to survey and compare general conditions,DA diameter,shunt direction,left ventricular function and complications.Result The hsPDA group had smaller GA （（30.5 ±2.1）vs.（31.6 ± 1.6）weeks,P =0.01） and greater proportion of pulmonary surfactant use and mechanical ventilation （2,3,5 d of birth） than the nhsPDA and the nPDA group （x2 =11.62,14.95,12.73,11.59,P =0.00,0.00,0.01,0.01）.Univariate and multivariate Logistic regression analysis indicated that the average length of stay （ALOS） was correlated with hsPDA （F =3.52 and P =0.03,OR =1.03 and P =0.02）.The ALOS was longer in the hsPDA group than in the nhsPDA and the nPDA group （（39 ± 23） vs.（30 ± 16） and （29 ± 13） d,P =0.02,0.03）.There was no significant difference in rates of mortality/giving-up of treatment among the three groups （5.9% （2/34）vs.0 （0/44） and 3.7% （1/27）,x2 =5.26,P =O.06）.Diastolic blood pressure and mean blood pressure were significantly lower in the hsPDA group than in the other two groups （P all 〈 0.05） at 2,3 and 5 days after birth and the pulse pressure was found significantly higher in the hsPDA group than in the nPDA group at 2 d after birth.Univariate and multivariate Logistic regression analysis demonstrat

关 键 词：婴儿 早产 动脉导管未闭 血流动力学 心脏 布洛芬 

分 类 号：R722.6[医药卫生—儿科]