Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern.
Initial Experience With Patent Ductus Arteriosus Ligation in Pre-term Infants With Bidirectional Shunt Pattern.
复制标题
DOI：
10.3389/fped.2020.591441
复制
发表时间：
2020
影响因子：
2.6
通讯作者：
Wu JR
中科院分区：
文献类型：
--
作者：
Yang MC;Liu HK;Wu HY;Tey SL;Yang YN;Wu CY;Wu JR
背景：动脉导管未闭（PDA）伴双向分流反映了危急的临床状况。早产儿PDA双向分流术的可操作性尚不清楚。本研究旨在探讨动脉导管未闭结扎术治疗早产儿双向分流动脉导管未闭的可行性和疗效。方法：本前瞻性研究纳入了2013年至2019年期间接受PDA结扎术的所有早产儿。根据PDA分流方向分为左向右分流组（A组）和双向分流组（B组）。分析了临床特征和术前合并症。比较两组的术中并发症、术后神经系统后遗症、坏死性小肠结肠炎、生存率和死亡率。结果：37例早产儿（A组18例，B组19例）入组。PDA手术时的平均月经后年龄分别为32.0 ± 1.3周和32.8 ± 1.5周。术前使用有创呼吸机的患者分别为44.4%和89.5%（A组vs. B）（p < 0.01）。B组患者对高频振荡康复支持的需求明显高于对照组。4例在暴露或结扎PDA时发生PDA破裂出血，均为B组，其中1例发生迟发性血胸。B组在术后30天内的早期手术死亡率较高（0 vs. 21.1%，p < 0.05），但只有1例死亡可归因于手术，这是由疼痛诱导的肺动脉高压危象引起的。5年生存率A组为100%，B组为73.7%（P < 0.05）。结论：我们不建议对有双向分流的早产儿进行常规PDA结扎。然而，如果双向分流符合PDA封堵的适应症，则不应成为绝对禁忌症。应密切监测双向分流PDA术中意外破裂和迟发性血胸。积极的术后疼痛控制也是必要的，以避免肺动脉高压危象。双向组的术后早期死亡率较高，这可能是其术前肺部状况较差所固有的。只有1例死亡与手术直接相关。
Background: Patent ductus arteriosus (PDA) with a bidirectional shunt reflects critical clinical conditions. The operability of PDA with a bidirectional shunt in pre-term infants is still not clearly clarified. This study aimed to investigate the feasibility and the outcomes of PDA ligation in pre-term infants with a bidirectional shunt PDA. Methods: All pre-term infants receiving PDA ligation between 2013 and 2019 were enrolled in this prospective study. Patients were allocated into two groups based on the shunting direction of PDA, which were the left-to-right group (group A) and the bidirectional group (group B). Clinical characteristics and pre-op comorbidities were analyzed. Intraoperative complications, post-op neurological sequelae, necrotizing enterocolitis, survival, and mortality were compared between these two groups. Results: Thirty-seven pre-term infants were enrolled (18 in group A, 19 in group B). The mean post-menstrual age at PDA surgery was 32.0 ± 1.3 and 32.8 ± 1.5 weeks, respectively. Before surgery, 44.4 and 89.5% (group A vs. B) of the patients were using invasive mechanical ventilator (p < 0.01). The requirement of high-frequency oscillatory ventilatory support was significantly higher in group B. PDA rupture-related bleeding during exposing PDA or ligating PDA occurred in four infants, and all were all in group B, including one with delayed hemothorax. Early surgical mortality within 30 days of surgery was higher in group B (0 vs. 21.1%, p < 0.05), but only one death could be attributed to the surgery, which was caused by a pain-induced pulmonary hypertension crisis. The 5-year survival was 100% in group A, and 73.7% in group B (p < 0.05). Conclusion: We did not recommend routine PDA ligation in pre-term infants with a bidirectional shunt. However, a bidirectional shunt should not be an absolute contraindication if they fulfill indications of PDA closure. Unexpected intraoperative PDA rupture and delayed hemothorax in a bidirectional shunt PDA should be carefully monitored. Aggressive post-op pain control is also warranted to avoid pulmonary hypertension crisis. The post-op early mortality rate was higher in the bidirectional group, which could be inherent to their poor pre-operative lung condition. Only one death was directly related to the surgery.
登录
查看更多内容
影响因子：
37.8
作者：
Schneider, Douglas J.;Moore, John W.
通讯作者：
Moore, John W.
影响因子：
4.6
作者：
Jacobs, Jeffrey P.;Mayer, John E., Jr.;Jacobs, Marshall L.
通讯作者：
Jacobs, Marshall L.
影响因子：
9.2
作者：
Wu JR;Yeh JL;Liou SF;Dai ZK;Wu BN;Hsu JH
通讯作者：
Hsu JH
影响因子：
9.6
作者：
Adatia, Ian;Kothari, Shyam S.;Feinstein, Jeffrey A.
通讯作者：
Feinstein, Jeffrey A.
影响因子：
3
作者：
Nada, Arwa;Bonachea, Elizabeth M.;Askenazi, David J.
通讯作者：
Askenazi, David J.