极早产儿和超早产儿生后早期有血流动力学意义动脉导管未闭闭合的影响因素研究  

Study on the influence factors for hemodynamically significant patent ductus arteriosus in the early life after birth of very preterm and extremely preterm infants

作　　者：王珊珊[1] 赵普[1] 黄丽萍[1] 胡雪峰[1] 李菁[1] WANG Shanshan;ZHAO Pu;HUANG Liping;HU Xuefeng;LI Jing(Department of Pediatrics,Shanghai First Maternity and Infant Hospital,Tongji University,Shanghai 201204,China)

机构地区：[1]同济大学附属妇产科医院新生儿科,上海201204

出　　处：《临床儿科杂志》2024年第10期863-867,共5页Journal of Clinical Pediatrics

基　　金：2022浦东医联体项目(No.PDYLT2022-08)。

摘　　要：目的 探讨影响极早产儿和超早产儿生后早期有血流动力学意义的动脉导管未闭(hsPDA)闭合的影响因素。方法 对2016年11月至2022年3月出生孕周<32周的172例伴有hsPDA的极早产儿和超早产儿进行回顾性分析,并根据出生后2周超声心动图复查结果分为PDA关闭组(n=83)和PDA组(n=89)。收集两组早产儿的临床资料进行病例对照研究。结果 单因素分析结果显示,hsPDA发生与PDA大小、胎龄、出生体重、1分钟Apgar评分、自然受孕、产前地塞米松、产前硫酸镁、妊娠期糖尿病、早产胎膜早破有关(P<0.05)。多因素logistic回归分析显示自然受孕、产前地塞米松和硫酸镁应用有利于hsPDA关闭,PDA内径较大、出生体重低和妊娠期糖尿病不利于hsPDA关闭(P<0.05)。结论 早期识别临床高危因素可以对极早产儿和超早产儿生后早期hsPDA进行危险预警,从而为早产儿hsPDA个体化治疗提供参考。Objective This study aimed to identify influence factors of hemodynamically significant patent ductus arteriosus(hsPDA)in very preterm and extremely preterm infants during the early postnatal period.Methods A retrospective analysis of 172 very preterm and extremely preterm infants were conducted from November 2016 to March 2022.Infants were categorized into a PDA closure group(n=83)and a PDA persistence group(n=89),based on the PDA diameter approximately two weeks after birth.Clinical data,including obstetric factors and the infants'conditions at birth,treatment,and complications,were analyzed using univariate and logistic regression methods.Results Univariate analysis indicated that hsPDA was correlated with PDA size,gestational age,birth weight,1-minute Apgar score,natural conception,prenatal dexamethasone,prenatal magnesium sulfate,maternal gestational diabetes,and premature rupture of membranes(P<0.05).Logistic regression identified natural conception,prenatal dexamethasone,and magnesium sulfate were helpful for PDA closure,while a large PDA diameter,low birth weight,and maternal gestational diabetes were significant risk factors for hsPDA persistence.Conclusion Clinical predictors can significantly aid in the early recognition of infants at high risk for hsPDA,guiding timely treatment strategies.

关 键 词：有血流动力学意义的动脉导管未闭 高危因素 早产儿 

分 类 号：R722.6[医药卫生—儿科]