不同日龄手术结扎动脉导管未闭对胎龄小于34周早产儿住院期间体格生长的影响  

Effect of surgical ligation of patent ductus arteriosus at different postnatal ages on physical growth of preterm infants with a gestational age under 34 weeks during hospitalization

作　　者：汪天姿 庄佳璐 孙彦隽[2] 贝斐 Wang Tianzi;Zhuang Jialu;SunYanjuan;Bei Fei(Department of Neonatology,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China;Department of Cardiovascular&Thoracic Surgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,Shanghai 200127,China)

机构地区：[1]上海交通大学医学院附属上海儿童医学中心新生儿科,上海200127 [2]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中华小儿外科杂志》2025年第3期217-221,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨胎龄<34周且存在血流动力学意义的动脉导管未闭(haemodynamically sig-nificant patent ductus arteriosus,hsPDA)的早产儿不同手术结扎时机对其住院期间体格生长的影响。方法回顾性分析上海交通大学医学院附属上海儿童医学中心2014年5月至2024年3月间收治的30例行hsPDA手术结扎、胎龄<34周早产儿的临床资料,其中男14例,女16例;出生胎龄为(28.6±2.4)周;出生体重为(1189.3±329.5)g。根据手术时日龄,将患儿分为早期手术组(≤28 d)和晚期手术组(>28 d),使用独立样本t检验、非参数检验(Mann-Whitney U检验)、χ^(2)检验或Fisher精切概率法比较两组早产儿住院期间的诊疗情况、出院时的体格生长状况和并发症。结果两组早产儿出生胎龄、出生体重等一般资料差异均无统计学意义(均P>0.05)。早期手术组和晚期手术组患儿手术时日龄分别为21.50(14.00,26.00)d和36.50(32.00,46.00)d,出院时日均体重增长分别为(18.41±3.74)g/d和(14.83±5.29)g/d,组间比较差异均有统计学意义(P<0.001,P=0.046)。早期手术组较晚期手术组住院天数更短[(78.29±20.17)d比(88.44±32.32)d]、住院费用更低[(17.22±6.34)万元比(19.40±7.44)万元],有创机械通气时间更少[(25.79±23.37)d比(38.64±30.59)d],但差异均无统计学意义(均P>0.05)。两组患儿在支气管肺发育不良、新生儿坏死性小肠结肠炎、早产儿视网膜病、Ⅲ级以上早产儿脑室内出血和脑室周围白质软化发生率间的差异无统计学意义。结论对于胎龄<34周的hsPDA早产儿,早期(生后日龄≤28 d)进行动脉导管未闭手术结扎有利于其住院期间的体重增长。Objective To explore the effect of different surgical ligation timing on the physical growth of premature infants with hemodynamically significant patent ductus arteriosus(hsPDA)with a gestational age under 34 weeks.Methods From May 2014 to March 2024,retrospective analysis was conducted for 30 premature infants with a gestational age of<34 weeks undergoing surgical ligation for hsPDA.There were 14 boys and 16 girls with a mean gestational age at birth of(28.6±2.4)weeks and a mean birth weight of(1,189.3±329.5)gram.Based on the age at the time of surgery they were assigned into two groups of early surgery(≤28 days)and late surgery(>28 days).Independent sample t,nonparametric(Mann-Whitney U),Chi-square(χ^(2))or Fisher's exact tests were utilized for comparing the diagnostic and therapeutic outcomes,physical growth status at discharge and complications between two groups.Results No statistically significant inter-group differences existed in gestational age at birth or birth weight(all P>0.05).Mean surgical age of early/late surgery group were 21.50(14.00,26.00)and 36.50(32.00,46.00)days and average daily weight gain at discharge(18.41±3.74)and(14.83±5.29)gram/day.There was statistically significant inter-group difference(P<0.001,P<0.046).As compared with late surgery group,early surgery group had a shorter hospitalization stay[(78.29±20.17)vs(88.44±32.32)day],lower hospitalization expense[(17.22±6.34)vs(19.40±7.44)ten thousand yuan]and shorter invasive mechanical ventilation time[(25.79±23.37)vs(38.64±30.59)days].However,the differences were not statistically significant(all P>0.05).No statistically significant inter-group differences existed in the incidence of bronchopulmonary dysplasia,neonatal necrotizing enterocolitis,retinopathy of prematurity,intraventricular hemorrhage above gradeⅢor periventricular leukomalacia.Conclusions For premature hsPDA infants with gestational age under 34 weeks,surgical ligation at an early stage(postnatal age≤28 days)may accelerate weight gain during hospitalizat

关 键 词：动脉导管未闭 早产儿 结扎 体格生长 

分 类 号：R722.6[医药卫生—儿科]