极低出生体重儿动脉导管未闭手术结扎时机的研究

Timing of surgical ligation of patent ductus arteriosus in very low birth weight infants

摘要:

目的 探讨极低出生体重儿（very low birth weight infant，VLBWI）动脉导管未闭（patent ductus arteriosus，PDA）手术结扎时机对预后的影响。 方法 回顾性分析2018年6月至2021年5月行经胸PDA手术结扎治疗的VLBWI临床资料。根据结扎时日龄分为早期结扎组（日龄≤21 d）和晚期结扎组（日龄>21 d），比较2组间围术期临床特征、并发症及病死率，并分析早期手术结扎的影响因素。 结果 共纳入72例VLBWI，早期结扎组19例（26%），晚期结扎组53例（74%）。2组间出生体重、胎龄、手术时体重、手术时日龄、术前有创机械通气率、术前无创机械通气率、肺出血及低血压发生率、术前72 h PDA内径/体重、术中PDA外径/体重、手术结扎后心脏综合征发生率及术后有创机械通气时间比较差异有统计学意义（P<0.05）。二元logistic回归分析显示：肺出血宜早期行PDA手术结扎（P<0.05）。早期结扎组和晚期结扎组术后并发症发生率和病死率差异无统计学意义（P>0.05）。 结论 当VLBWI生后出现肺出血并经心脏超声证实存在有血流动力学意义的PDA时，可早期行手术结扎治疗，但应警惕手术结扎后心脏综合征的发生。另外，PDA的早期结扎并未增加手术本身、远期并发症及死亡的风险，是一种安全、可行的治疗方案。 用格式：引用格式:中国当代儿科杂志，2022，24（5）：500-506

Abstract:

Objective To study the effect of timing of surgical ligation of patent ductus arteriosus (PDA) on the prognosis of very low birth weight infants (VLBWI). Methods The medical data of VLBWI who underwent transthoracic ligation for PDA from June 2018 to May 2021 were reviewed retrospectively. The infants were divided into early ligation group (≤21 days of age) and late ligation group (>21 days of age) based on the age of ligation. The two groups were compared in terms of perioperative clinical features, complications, and mortality. The risk factors for early surgical ligation were analyzed. Results A total of 72 VLBWI were enrolled, with 19 infants (26%) in the early ligation group and 53 infants (74%) in the late ligation group. There were significant differences in birth weight, gestational age, weight at operation, days of age at operation, rates of preoperative invasive and noninvasive mechanical ventilation, incidence rate of pulmonary hemorrhage, incidence rate of hypotension, preoperative PDA internal diameter (mm/kg), intraoperative PDA external diameter (mm/kg), incidence rate of post-ligation cardiac syndrome, and duration of postoperative invasive mechanical ventilation between the two groups (P<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (P<0.05). There were no significant differences in the incidence rates of post-operative complications and the mortality rate between the early ligation and late ligation groups. Conclusions Early surgical ligation may be performed for VLBWI who are experiencing pulmonary hemorrhage and hemodynamically significant PDA confirmed by cardiac ultrasound after birth. However, post-ligation cardiac syndrome should attract enough attention. In addition, early surgical ligation of PDA does not increase the risk of surgery-related and long-term complications or death, indicating that it is a safe and feasible treatment option. Citation:Chinese Journal of Contemporary Pediatrics, 2022, 24(5): 500-506