单卵双胎早产儿动脉导管未闭外科结扎两例分析并文献复习  

Analysis of two cases of patent ductus arteriosus ligation in preterm identical twins and literature review

作　　者：曹祥 陈小丁 羊玲 陈仁伟 李艳 莫泽来 向伟 CAO Xiang;CHEN Xiao-ding;YANG Ling;CHEN Ren-wei;LI Yan;MO Ze-ai;XIANG Wei(Neonatology Department,Hainan Women and Children's Medical Center,Children's Hospital of Hainan Medical University,Haikou,Hainan 570206,China;Cardio-Thoracic Surgery Department,Hainan Women and Children's Medical Center,Children's Hospital of Hainan Medical University,Haikou,Hainan 570206,China;Anesthesiology Department,Hainan Women and Children's Medical Center,Children's Hospital of Hainan Medical University, Haikou,Hainan 570206,China;Ultrasound Imaging Department,Hainan Women and Children's Medical Center,Children’s Hospital of Hainan Medical University, Haikou,Hainan 570206,China;Key Laboratory of Tropical Translational Medicine, Ministry of Education, Hainan Medical University,Haikou,Hainan 571199,China)

机构地区：[1]海南省妇女儿童医学中心(海南医学院附属儿童医院)新生儿科,海南海口570206 [2]海南省妇女儿童医学中心(海南医学院附属儿童医院)心胸外科,海南海口570206 [3]海南省妇女儿童医学中心(海南医学院附属儿童医院)麻醉科,海南海口570206 [4]海南省妇女儿童医学中心(海南医学院附属儿童医院)超声影像科,海南海口570206 [5]海南医学院热带转化医学教育部重点实验室,海南海口571199

出　　处：《海南医学院学报》2020年第17期1343-1347,共5页Journal of Hainan Medical University

基　　金：海南省重大科技专项(2019)(ZDKJ2019010)。

摘　　要：目的:探讨单卵双胎早产儿动脉导管未闭(PDA)的外科结扎治疗时机及治疗效果。方法:回顾性分析我院新生儿科住院的2例有显著血流动力学改变的PDA双胎早产儿治疗经过,并文献检索双胎早产儿PDA结扎治疗的病例。结果:2例病例为单绒毛膜双羊膜囊自然受孕双胎,胎龄30^+2周,大婴出生体重1510 g,小婴出生体重780 g,双胎体重相差48.3%,2例心脏超声检查发现PDA,有明显血流动力学改变的临床表现,经多次心脏超声检查提示PDA较大(2.8~3.5 mm)、左向右分流且有左房左室增大等表现,均经两个疗程布洛芬治疗无效,血N端脑钠肽前体明显升高,最终均接受外科手术结扎治疗,症状明显改善,无手术相关并发症。文献检索共报道双胎早产儿PDA结扎12例(含本文2例),其中2例死亡,9例治愈出院,1例明显好转。资料较完整6例患儿,4例系单卵双胎,2例不详。结论:单卵双胎早产儿具有相同的遗传基础,如胎龄小、双胎体重相差>30%,应警惕需同时进行PDA结扎的可能。有显著血流动力学改变的PDA经布洛芬治疗无效者,尽早行外科干预,手术结扎安全有效。Objective To investigate the timing and effect of surgical ligation in the treatment of patent ductus arteriosus(PDA)in preterm identical twins.Methods Retrospective analysis was made on the treatment of 2 cases of preterm twins with hemodynamic significant PDA(hsPDA)with corresponding clinical manifestation in our neonatology department,and literatures of PDA ligation for preterm twins were retrieved.Results These 2 cases were naturally conceived monochorionic diamniotic twins,with gestational age 30^+2 weeks,1510g and 780g of birth weight for larger twin and smaller twin respectively,and a birth weight discordance of 48.3%.They both developed hsPDA with corresponding clinical manifestation,series echocardiography showed evidence of left to right shunting and cardiac insufficiency which were left atrial and ventricular enlargement,large PDA(2.8-3.5mm),failed in two courses of ibuprofen with N-terminal pro-brain natriuretic peptide level increased significantly,and finally received surgical ligation with significant clinical improvement and no related complications.Totally 12 cases were found from literature search,among which 2 cases discussed here,2 died,9 were cured and 1 improved significantly.Among 6 cases whose detailed information were available,4 infants were identical twins,and 2 unknown.Conclusions Preterm identical twins have the same genetic basis,the possibility of PDA ligation for both the larger twin and smaller twin should be alerted if the gestaional age is small and birth weight discordance is above 30%.If preterm twins have hsPDA who may fail ibuprofen treatment,surgical ligation should be considered early,and it is safe and effective.

关 键 词：单卵双胎 早产儿 动脉导管结扎 

分 类 号：R722.6[医药卫生—儿科]