摘要
目的评估有显著血流动力学影响的动脉导管未闭（hsPDA）极低出生体质量儿（VLBWI）手术结扎的疗效，探讨VLBWI hsPDA手术治疗的指征、时机、疗效及安全性。方法回顾性分析广东省人民医院2006年1月至2010年12月NICU收治的11例VLBWI，经心脏彩超诊断为hsPDA，手术指征是合并各种严重并发症，内科处理无效，分析行手术结扎治疗患儿的临床和随访资料。结果患儿出生胎龄中位数为29周（26～32周），出生体质量平均为（1166．8±283．9）g，PDA直径为2．0～5．5mm，手术后最常见的并发症是呼吸机相关性肺炎。围术期无一例死亡，总住院天数平均（67．1±36．1）d，住院过程中需要用氧时间平均（60．9±28．0）d，总的机械通气时间平均（33．6±13．2）d，其中术前机械通气时间平均为（22．9±9．3）d，术后机械通气时间为（11．4±6．9）d，术后机械通气时间较术前明显缩短（P〈0．05）。本组在住院过程中各种早产儿相关并发症总的发生情况包括呼吸暂停9例（81．8％）、BPD7例（63．6％）、代谢性酸中毒5例（45．5％）、脓毒症4例（36．4％）、ROP4例（36．4％）、NEC3例（27．3％）、脑损伤3例（27．3％）、肺出血2例（18．2％）。术后随访中位数为44个月，其中1例因意外窒息死亡，存活率为90．9％。结论外科手术结扎治疗VLBWI hsPDA的疗效明确，可缩短机械通气时间，降低治疗费用，降低病死率。
Objective To evaluate the efficacy of surgical ligation in very low birth weight infant （VLBWI） with hemodynamic significant patent ductus arteriosus （hsPDA）, and further investigate the indication, timing and safety of surgical intervention of VLBWI with hsPDA. Methods Retrospective analysis was performed for the medical records of 11 cases of VLBWI with hsPDA confirmed by echocardiography who received operation between January 2006 and December 2010 in Guangdong General Hospital. The indications of PDA ligation were patients with invalid medical treatment combined with different kinds of complication of hsPDA. Results All infants＇ median gestational age was 29 weeks （26 - 32 weeks）, mean birth weight was （ 1166.8 ± 283.9） g, and the hsPDA diameter ranged from 2.0 - 5.5 mm. The most common complication of operation was ventilator-associated pneumonia. The operation mortality was O,the mean hospital stay was （67.1 ± 36.1 ） days, and duration of oxygen dependence was （60.9 ±28.0） days. Total duration of mechanical ventilation dependence was （33.6 ±13.2 ） days. After ligation, duration of mechanical ventilation dependence was （ 11.4 ± 6.9 ） days, which was significantly shorter than before ligation [ （ 22.9 ± 9.3 ） days ] （ P 〈 0. 05 ）. The incidence of apnea, broncho pulmonary dysplasia, metabolic acidosis, septicemia, retinopathy of prematurity, necrotizing enterocolitis, intraventricular haemorrhage and pulmonary hemorrhage were 81.8 % , 63.6 % ,45.5 % , 36.4% ,36.4% ,27.3% ,27.3% and 18.2% respectively. Followed up to 44 months after surgery,there was only 1 infant who died of accidental asphyxia, so total survival rate was 90.9%. Conclusion Surgical ligation was an effective therapy of VLBWI with hsPDA,as it can lessen the duration of mechanical ventilation dependence, treatment cost and decrease the mortality.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第1期69-72,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
“十一五”国家科技支撑计划项目（2006BAI01A08）
广东省科技计划项目（2009B030801263）
关键词
动脉导管未闭
极低出生体质量儿
手术结扎
超声心动图
并发症
Patent ductus arteriosus
Very low birth weight infant
Surgical ligation
Echocardiography
Complication
