新生儿动脉导管未闭急诊手术治疗的研究  

Emergency surgical closure of neonatal patent ductus arteriosus

作　　者：郑祥鑫 周可[1] 李东玉[1] 王文生[1] 

机构地区：[1]中国医科大学附属盛京医院心脏外科,沈阳110004 [2]浙江大学医学院附属第二医院综合ICU,杭州310052

出　　处：《中国小儿急救医学》2015年第12期861-864,共4页Chinese Pediatric Emergency Medicine

摘　　要：目的探讨新生儿动脉导管未闭急诊手术治疗经验以及评价患儿的术后疗效。方法回顾性分析2012年7月至2015年2月我科治疗的31例新生儿动脉导管未闭患儿的临床资料，其中男15例，女16例，早产儿28例，足月儿3例，平均出生胎龄30＋4周（26＋2周～39＋3周），出生时平均体重和体重〉1500g组（1159．0±729．2）g，手术时平均体重（1522．0±644．5）g，其中6例患儿采取腋下直切口，25例患儿采取后外侧切口，经第4肋间进人胸腔行动脉导管结扎术。按体重将患儿分为〈1500g组（χ2=24）及〉1500g组（χ2=7），分析临床转归情况。结果31例患儿均顺利完成手术，无手术死亡，手术平均时间（62．7±29．9）min，术后平均呼吸机辅助通气时间（5．5±4．7）d。体重〈1500g组和体重〉1500g组患儿动脉导管未闭术后呼吸机辅助时问分别为（7．2±2．3）d和（4．9±2．4）d，两组比较差异有统计学意义（P〈0．001），术后住院时间分别为（45．3±11．0）d和（20．4±14．5）d，两组比较差异无统计学意义（P〉0．05）。28例患儿术后恢复良好顺利出院，2例患儿自动退院，1例患儿因心力衰竭、高钾血症、心律失常抢救无效死亡。结论新生儿粗大的动脉导管未闭会影响心肺功能，特别是存在充血性心力衰竭、多种合并症、长时间呼吸机辅助通气、药物治疗失败的动脉导管未闭，需及时手术结扎导管，阻断分流，改善心肺功能，有助于顺利撤除呼吸机，提高生存率。Objective To explore the experience of emergency operation for patent ductus arteriosus （PDA） in neonates and to assess the therapeutic effect. Methods The clinical data of 31 PDA neonates（ 15 male, 16 female） treated in our department from July 2012 to February 2015 were reviewed retrospectively. Of these cases, 28 were preterm infants and 3 were full term infants. Mean gestational age was 30 ＋4 weeks ranging from 26 ＋2 to 39 ＋3 weeks. Mean birth weight and weight at operation was （ 1 159. 0 ± 729. 2） g and （1 522. 0 ± 644. 5 ） g, respectively. We operated with left transaxillary straight incision in 6 cases and posterolateral minimal incision in 25 cases, and the pleural cavity was entered via the 4th intercostal space. All the neonates were divided into 〈 1 500 g group（ n = 24） and 〉 1 500 g group（ n = 7 ） by weight, the clinical prognosis were analysized. Results All 31 operations were finished successfully. No deaths occurred as a result of surgery. Average time of operation was （ 62. 7 ± 29.9 ） rain. Mean time of mchanical ventilation after the operation among survivors was （5.5 ± 4. 7 ） d. The time of mechanical ventilation between 〈 1 500 g group and 〉 1 500 g group were （ 7.2 ± 2. 3 ） d and （4. 9 ± 2.4 ） d respectively, and there was significant difference between two groups（ P 〈 0. 001 ）. The time of hospital stay were （45.3 ± 11.0） d and （20.4 ±14. 5 ） d respectively between two groups （ P 〉 0. 05 ）. Twenty-eight cases recovered and released from the hospital successfully. Two cases quited the treatment themselves and 1 succumbed to death because of heart failure, hyperkalemia and arrhythmia. ConclusionEmergency surgical closure is a safe and effective method for the treatment of neonatal large PDA, especially with congestive heart failure, a variety of complications, long time ventilator dependence, medical treatment failure, which should be ligatured timely as it can have severe influence on the cardiopulmonary function

关 键 词：新生儿 早产儿 动脉导管未闭 急诊手术 

分 类 号：R722.1[医药卫生—儿科]