极低出生体重儿动脉导管未闭手术结扎的时机
[Timing of surgical ligation of patent ductus arteriosus in very low birth weight infants].
作者信息
Liu Tai-Xiang, Ma Xiao-Lu, Chen Zheng, Shi Li-Ping
机构信息
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine/National Clinical Research Center for Child Health, Hangzhou 310052, China.
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2022 May 15;24(5):500-506. doi: 10.7499/j.issn.1008-8830.2112151.
OBJECTIVES
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 (<0.05). A binary logistic regression analysis showed that pulmonary hemorrhage was an indication of early surgical ligation of PDA (<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.
目的
研究动脉导管未闭（PDA）手术结扎时机对极低出生体重儿（VLBWI）预后的影响。
方法
回顾性分析2018年6月至2021年5月因PDA行胸腔镜结扎术的VLBWI的医学资料。根据结扎年龄将患儿分为早期结扎组（≤21日龄）和晚期结扎组（>21日龄）。比较两组围手术期临床特征、并发症及死亡率。分析早期手术结扎的危险因素。
结果
共纳入72例VLBWI，早期结扎组19例（26%），晚期结扎组53例（74%）。两组在出生体重、胎龄、手术时体重、手术日龄、术前有创及无创机械通气率、肺出血发生率、低血压发生率、术前PDA内径（mm/kg）、术中PDA外径（mm/kg）、结扎后心脏综合征发生率及术后有创机械通气时间方面差异有统计学意义（<0.05）。二元logistic回归分析显示肺出血是PDA早期手术结扎的指征（<0.05）。早期结扎组与晚期结扎组术后并发症发生率及死亡率差异无统计学意义。
结论
出生后经心脏超声证实有肺出血且PDA对血流动力学有显著影响的VLBWI可进行早期手术结扎。然而，结扎后心脏综合征应引起足够重视。此外，PDA早期手术结扎不会增加手术相关及长期并发症或死亡风险，表明其是一种安全可行的治疗选择。
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