有血流动力学意义的动脉导管未闭早产儿手术治疗危险因素巢式病例对照研究  

Risk factors for hemodynamically significant patent ductus arteriosus in preterm infants requiring surgical ligation:a nested case-control study

作　　者：姜静婧 李正红[1,2] 张朕杰 李蕴微 丁娟 李佳欣 万伟琳 Jiang Jingjing;Li Zhenghong;Zhang Zhenjie;Li Yunwei;Ding Juan;Li Jiaxin;Wan Weilin(Department of Pediatrics,Peking Union Medical College Hospital,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China;State Key Laboratory of Complex Severe and Rare Diseases,Beijing 100730,China;Graduate School,Chinese Academy of Medical Science,Peking Union Medical College,Beijing 100730,China)

机构地区：[1]中国医学科学院,北京协和医学院,北京协和医院儿科,北京100730 [2]疑难重症及罕见病国家重点实验室,北京100730 [3]中国医学科学院,北京协和医学院研究生院,北京100730

出　　处：《中华实用儿科临床杂志》2023年第3期210-214,共5页Chinese Journal of Applied Clinical Pediatrics

基　　金：中央高水平医院临床科研(2022-PUMCH-B-077)。

摘　　要：目的分析具有血流动力学意义的动脉导管未闭(hs-PDA)早产儿需手术治疗的危险因素,探讨hs-PDA早产儿的手术治疗指征。方法应用巢式病例对照研究方法,回顾性分析北京协和医院新生儿重症监护病房2007年1月至2020年5月收治的胎龄<30周且诊断为hs-PDA的早产儿病例资料,手术治疗的hs-PDA患儿为手术组,按1∶2的比例随机匹配同胎龄、同性别未手术治疗的hs-PDA病例作为对照组。比较2组的孕母孕期、早产儿出生时及出生后的临床资料。计量资料采用独立样本t检验或Mann-Whitney U检验;分类计数资料采用Fisher's确切概率法比较,采用条件Logistic回归分析hs-PDA早产儿需手术治疗的危险因素。结果研究期间共诊断hs-PDA早产儿182例,其中手术组10例,PDA结扎手术日龄为30.5(22.7,37.0)d,术前有创通气时间中位数为9.7(17.5,27.2)d。与对照组(20例)比较,手术组早产儿出生体重较低[(891.5±118.0)g比(1054.4±230.2)g,t=2.091],动脉导管直径更宽[3.2(2.8,4.0)mm比2.0(2.0,3.0)mm,Z=-3.300],应用肺表面活性物质次数更多[2(1,3)次比1(1,2)次,Z=-2.440],有创通气时间更长[25.0(18.7,38.2)d比3.0(1.0,7.5)d,Z=-3.688],出生后第14天吸入氧浓度更高[29(25,36)%比21(21,29)%,Z=-2.358],达足量肠内喂养时间更长[48.2(51.5,63.5)d比42.5(23.5,48.0)d,Z=2.789],最大血管活性-正性肌力药物评分(VIS)更高[3.0(0,3.5)分比0(0,0)分,Z=-2.630],差异均有统计学意义(均P<0.05)。单因素Logistic回归分析显示,手术组动脉导管直径、应用肺表面活性物质次数、最大VIS评分、达足量肠内喂养时间与hs-PDA需手术治疗均相关(均P<0.05);多因素Logistic回归分析显示,有创通气时间(OR=0.747,95%CI:0.560~0.998,P=0.048)为hs-PDA早产儿需手术治疗的独立危险因素。结论hs-PDA早产儿需手术治疗相关因素包括动脉导管直径较宽、需多次应用肺表面活性物质、第14天吸入氧浓度较高、达足量肠内喂养时间较长,hs-PDAObjective To analyze the risk factors for premature infants with hemodynamically significant patent ductus arteriosus(hs-PDA)requiring surgical treatment,and to explore the indications for surgical treatment in premature infants with hs-PDA.Methods A nested case-control study was conducted.The data of premature infants with gestational age<30 weeks who were diagnosed with hs-PDA in the Neonatal Intensive Care Unit of Peking Union Medical College Hospital from January 2007 to May 2020 were analyzed retrospectively.The hs-PDA patients treated surgically were included in the operation group.The hs-PDA patients of the same gestational age and gender who were not treated surgically were taken as the control group.The ratio of the case number between the operation and control groups was 1∶2.The clinical data during pregnancy,at birth and after birth of premature infants were compared between the 2 groups.The measurement data were tested by the independent sample t test or Mann-Whitney U test.The classification and enumeration data were compared by the Fisher's exact probability method.The risk factors for premature infants with hs-PDA requiring surgical treatment were analyzed by the conditional Logistic regression method.Results A total of 182 premature infants with hs-PDA were enrolled in the study,including 10 in the operation group and 20 in the control group.The patients underwent PDA ligation 30.5(22.7,37.0)d after birth,and the median preo-perative invasive ventilation duration was 9.7(17.5,27.2)d.Compared with the control group(20 cases),the preterm infants in the operation group had a lower birth weight[(891.5±118.0)g vs.(1054.4±230.2)g,t=2.091],a wider arterial duct diameter[3.2(2.8,4.0)mm vs.2.0(2.0,3.0)mm,Z=-3.300],and longer invasive ventilation duration[25.0(18.7,38.2)d vs.3.0(1.0,7.5)d,Z=-3.688].Besides,the operation group applied the pulmonary surfactant for more times[2(1,3)times vs.1(1,2)times,Z=-2.440],and inhaled a higher concentration of oxygen on the 14th day after birth[29(25,36)%vs.21(21,29)

关 键 词：动脉导管结扎 动脉导管未闭 婴儿 早产 巢式病例对照研究 危险因素 

分 类 号：R722.6[医药卫生—儿科]