超早产儿动脉导管结扎术的疗效分析  

Analysis of the effect of ligation of ductus arteriosus in premature infants

作　　者：施旭聪 翁建彬 陈鸣艳[3] 张泽伟[1] Shi Xucong;Weng Jianbin;Chen Mingyan;Zhang Zewei(Department of Cardiac Surgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,National Children's Regional Medical Center,Hangzhou 310052,China;Department of Neurosurgery,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,National Children's Regional Medical Center,Hangzhou 310052,China;Department of Neonatal Intensive Care Unit,Children's Hospital,Zhejiang University School of Medicine,National Clinical Research Center for Children's Health,National Children's Regional Medical Center,Hangzhou 310052,China)

机构地区：[1]浙江大学医学院附属儿童医院心脏外科,国家儿童健康与疾病临床医学研究中心,国家儿童区域医疗中心,杭州310052 [2]浙江大学医学院附属儿童医院神经外科,国家儿童健康与疾病临床医学研究中心,国家儿童区域医疗中心,杭州310052 [3]浙江大学医学院附属儿童医院新生儿重症监护室,国家儿童健康与疾病临床医学研究中心,国家儿童区域医疗中心,杭州310052

出　　处：《中华小儿外科杂志》2022年第6期499-503,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨超早产儿动脉导管未闭(patent ductus arteriosus,PDA)手术治疗的疗效及安全性。方法收集2015年1月至2019年12月在浙江大学医学院附属儿童医院新生儿重症监护室收治并在心脏外科进行手术干预的49例PDA超早产儿的临床资料。其中,男27例,女22例;均为胎龄<28周的早产儿,平均出生胎龄为26^(+5)周,胎龄范围为24^(+5)~27^(+6)周;多胎妊娠占38.8%(19/49);出生体重为(930±148)g;术前超声评估PDA直径为(4.0±0.8)mm;术前约有1.6次药物治疗疗程。观察患儿的基本临床资料、手术治疗的早期预后、住院期间病死率、手术相关并发症,比较术前和术后呼吸机支持时间、脱离氧疗的时间等,总结PDA结扎术治疗超早产儿的临床特征和治疗效果。结果所有患儿的手术时间为(52±16)min,手术时平均日龄为42.4 d,手术时平均体重为1.68 kg,术前PDA直径的中位数为3.8 mm,出院时平均纠正年龄为42^(+6)周,出院时平均体重为3.47 kg。围手术期无死亡病例,所有患儿术后无残瘘,均达到即刻闭合。2例患儿术前已存在左侧声带麻痹,术后无新增神经损伤的病例;术后气胸占10.2%(5/49)。出院前非手术相关死亡4例,院内病死率为8.2%(4/49)。术前有创机械通气支持占85.7%(42/49),无创正压通气支持占14.3%(7/49)。住院期间有创机械通气总时间为(42±37)d,总的呼吸机支持(有创机械通气+无创正压通气)时间为(73±34)d。有创机械通气时间、总的呼吸机支持时间在术前和术后的差值分别为(12.4±26.5)d和(32.2±35.0)d,差异均具有统计学意义,P值分别为P=0.003和P<0.001。生存分析发现多胎妊娠、手术时体重≥1.5 kg、PDA直径<3.8 mm的患儿术后可以更早撤离呼吸机治疗及脱离氧疗。结论运用动脉导管结扎术治疗超早产儿PDA是安全、有效的。Objective To explore the efficacy and safety of patent ductus arteriosus(PDA)ligation in extremely premature infants.Methods Clinical data were retrospectively reviewed for 49 extremely preterm PDA infants admitted into Neonatal Intensive Care Unit of Children's Hospital,Zhejiang University School of Medicine.They underwent surgical intervention at Department of Cardiac Surgery from January 2015 to December 2019.There were 27 boys and 22 girls with a gestational age<28 weeks,an average gestational age of 26^(+5) weeks and a gestational age range of 24^(+5) to 27^(+6) weeks;multiple pregnancies accounted for 38.8%(19/49);birth weight was(930±148)g;diameter of PDA assessed by preoperative ultrasound was(4.0±0.8)mm;there were approximately 1.6 courses of drug treatment.Basic clinical data,early surgical prognosis,inhospital mortality and operation-related complications were recorded.Durations of ventilator support and oxygen therapy before and after operation were compared.And clinical characteristics and therapeutic effect of PDA ligation were summarized.Results Operative duration was(52±16)min,average operative age 42.4 days,average operative weight 1.68 kg,median diameter of PDA 3.8 mm,average corrected age at discharge 42^(+6) weeks and average weight at discharge 3.47 kg.Without mortality,none had residual fistula postoperatively and achieved immediate closure.Two children had left vocal cord paralysis preoperatively.No new case of nerve injury occurred postoperatively.Postoperative pneumothorax accounted for 10.2%(5/49).Four pre-discharge deaths were not related with surgery and there was an in-hospital mortality rate of 8.2%(4/49).Preoperative invasive mechanical ventilation support accounted for 85.7%(42/49)and non-invasive positive pressure ventilation support 14.3%(7/49).Total mechanical ventilation time during hospitalization was(42±37)days and total ventilator support time of invasive mechanical ventilation and non-invasive positive pressure ventilation was(73±34)days.The differences between pre and

关 键 词：动脉导管未闭 超早产儿 动脉导管结扎术 安全有效 

分 类 号：R722.6[医药卫生—儿科]