中国极早产儿动脉导管未闭的治疗现状  

Treatment of patent ductus arteriosus in very preterm infants in China

作　　者：钱爱民 程锐[1] 顾昕玥 殷荣 白瑞苗 杜娟 孙梦雅[6] 程萍 Shoo K.Lee 杜立中[9] 曹云 周文浩 赵幽燕 蒋思远 无 Qian Aimin;Cheng Rui;Gu Xinyue;Yin Rong;Bai Ruimiao;Du Juan;Sun Mengya;Cheng Ping;Shoo K.Lee;Du Lizhong;Cao Yun;Zhou Wenhao;Zhao Youyan;Jiang Siyuan;无(Department of Neonatology,Children′s Hospital of Nanjing Medical University,Nanjing 210008,China;National Health Commission(NHC)Key Laboratory of Neonatal Diseases,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Department of Neonatology,Children′s Hospital of Fudan University,National Children′s Medical Center,Shanghai 201102,China;Department of Neonatology,Northwest Women′s and Children′s Hospital,Xi′an 710061,China;Department of Neonatology,Beijing Children′s Hospital,Capital Medical University,National Center of Children′s Health,Beijing 100045,China;Department of Neonatology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China;Department of Neonatology,Children′s Hospital Affiliated to Zhengzhou University,Henan Children′s Hospital,Zhengzhou Children′s Hospital,Zhengzhou 450018,China;the Maternal Infant Care Research Center(MiCARE),Mount Sinai Hospital,Toronto M5G 1X5,Canada;Department of Neonatology,Children′s Hospital,Zhejiang University School of Medicine,Hangzhou 310051,China;the Chinese Neonatal Network)

机构地区：[1]南京医科大学附属儿童医院新生儿医疗中心,南京210008 [2]国家儿童医学中心复旦大学附属儿科医院国家卫生健康委员会新生儿疾病重点实验室,上海201102 [3]国家儿童医学中心复旦大学附属儿科医院新生儿科,上海201102 [4]西北妇女儿童医院新生儿科,西安710061 [5]国家儿童医学中心首都医科大学附属北京儿童医院新生儿中心,北京100045 [6]青岛大学附属医院新生儿科,青岛266000 [7]郑州大学附属儿童医院河南省儿童医院郑州儿童医院新生儿科,郑州450018 [8]加拿大西奈山医院母婴健康研究中心,多伦多M5G 1X5 [9]浙江大学医学院附属儿童医院新生儿科,杭州310051网 [10]中国新生儿协作网

出　　处：《中华儿科杂志》2023年第10期896-901,共6页Chinese Journal of Pediatrics

基　　金：加拿大卫生研究院基金(CTP87518)。

摘　　要：目的总结2019—2021年中国新生儿协作网(CHNN)各单位收治的极早产儿中动脉导管未闭(PDA)的治疗现状和变化趋势以及单位间治疗差异。方法横断面研究基于CHNN极早产儿队列,纳入2019—2021年CHNN 79家三级新生儿重症监护病房(NICU)收治的所有入院≤3日龄的22525例极早产儿(出生胎龄<32周)。描述所有极早产儿以及不同出生胎龄(≤26、27~28、29~31周)组的PDA治疗率以及药物和手术治疗情况。PDA定义为住院期间通过心脏超声诊断的PDA;PDA治疗率为接受过PDA药物和(或)手术治疗的极早产儿人数/所有极早产儿人数。使用Logistic回归检验分析研究3年间及不同出生胎龄组PDA治疗率的变化趋势。建立多元Logistic回归模型计算不同单位PDA治疗的标准化比率(SR),以比较调整人群特征后单位间PDA治疗率的差异。结果22525例极早产儿中男12615例(56.0%),出生胎龄30.0(28.6,31.0)周,出生体重1310(1100,1540)g,经超声心动图诊断的PDA 49.7%(11186/22525),所有极早产儿PDA治疗率为16.8%(3795/22525)。在3762例接受了药物治疗的极早产儿中,首次药物治疗以布洛芬为主[93.4%(3515例)],首次药物治疗的年龄为6(4,10)日龄;59.3%(2231例)的极早产儿在首次药物治疗时已经撤离了有创呼吸支持,82.2%(3092例)的极早产儿仅接受1个疗程药物治疗。在143例接受了手术治疗的极早产儿中,手术治疗的年龄为32(22,46)日龄。2019—2021年3年间,极早产儿PDA治疗率差异无统计学意义(P=0.650)。PDA治疗率随着出生胎龄的增加而降低(P<0.001)。出生胎龄≤26、27~28、29~31周极早产儿PDA治疗率分别为39.6%(688/1737)、25.9%(1319/5098)、11.4%(1788/15690)。极早产儿总数≥100例的单位共61家,这些单位的极早产儿PDA治疗率范围为0(0/116)~47.4%(376/793)。在调整患儿基本特征后,61家单位极早产儿PDA治疗的SR范围为0(95%CI 0~0.3)~3.4(95%CI 3.1~3.8)。结论2019—2021年中国新生儿协作单位收�ObjectiveTo describe the current status and trends in the treatment of patent ductus arteriosus(PDA)among very preterm infants(VPI)admitted to the neonatal intensive care units(NICU)of the Chinese Neonatal Network(CHNN)from 2019 to 2021,and to compare the differences in PDA treatment among these units.MethodsThis was a cross-sectional study based on the CHNN VPI cohort,all of 22525 VPI(gestational age<32 weeks)admitted to 79 tertiary NICU within 3 days of age from 2019 to 2021 were included.The overall PDA treatment rates were calculated,as well as the rates of infants with different gestational ages(≤26,27-28,29-31 weeks),and pharmacological and surgical treatments were described.PDA was defined as those diagnosed by echocardiography during hospitalization.The PDA treatment rate was defined as the number of VPI who had received medication treatment and(or)surgical ligation of PDA divided by the number of all VPI.Logistic regression was used to investigate the changes in PDA treatment rates over the 3 years and the differences between gestational age groups.A multivariate Logistic regression model was constructed to compute the standardized ratio(SR)of PDA treatment across different units,to compare the rates after adjusting for population characteristics.ResultsA total of 22525 VPI were included in the study,with a gestational age of 30.0(28.6,31.0)weeks and birth weight of 1310(1100,1540)g;56.0%(12615)of them were male.PDA was diagnosed by echocardiography in 49.7%(11186/22525)of all VPI,and the overall PDA treatment rate was 16.8%(3795/22525).Of 3762 VPI who received medication treatment,the main first-line medication used was ibuprofen(93.4%(3515/3762))and the postnatal day of first medication treatment was 6(4,10)days of age;59.3%(2231/3762)of the VPI had been weaned from invasive respiratory support during the first medication treatment,and 82.2%(3092/3762)of the infants received only one course of medication treatment.A total of 143 VPI underwent surgery,which was conducted on 32(22,46)days of age.Over t

关 键 词：动脉导管未闭 重症监护病房 新生儿 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]