Toward rational management of patent ductus arteriosus: ductal disease staging and first line paracetamol
Toward rational management of patent ductus arteriosus: ductal disease staging and first line paracetamol
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DOI：
10.1080/14767058.2019.1702949
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发表时间：
2019-12-27
影响因子：
1.8
通讯作者：
Tan, Kenneth
中科院分区：
文献类型：
--
作者：
Sehgal, Arvind;Nitzan, Itamar;Tan, Kenneth
目的：通过超声心动图分层，研究扑热息痛(PCM)作为动脉导管未闭(SPDA)闭合的一线治疗方法。方法：在这项回顾性观察研究中，包括预先公布的PDA大小和速度、PDA与左肺动脉的比值、主干和LPA的舒张期血流、LA/Ao比值和左心室/主动脉比值作为分流严重程度。成功的闭合被定义为成功闭合或分数下降50%。对接受治疗和未接受治疗的sPDA婴儿进行比较。结果：2017年11月至2018年11月，共收治胎龄23~31周(+6周)的新生儿227例，诊断为PDA 50例(22%)，PCM治疗32例(14%)。治疗成功23/32(72%)，在26周GA(62.5%对100%，p=.07)和BW>；1000g(65.4vs100%，p=.14)治疗时更高。单变量分析仅对GA有统计学意义。对18例婴幼儿进行保守治疗。接受治疗的婴儿GA和BW较低，综合回声评分较高(14.4+/-0.5比19+/-0.4，p<；.001)。结论：综合评分有助于减少暴露，并更多地关注分流严重程度较高的GA和BW较低的婴儿。
Aims: To study paracetamol (PCM) use as first line therapy for significant patent ductus arteriosus (sPDA) closure, stratified by echocardiography. Methods: In this retrospective observational study, a prepublished score comprising PDA size and velocity, PDA:left pulmonary artery ratio, diastolic flow in main and LPA, LA:Ao ratio and left ventricular:aortic ratio were included for shunt severity. Successful closure was defined a priori as closure or >= 50% reduction in score. Comparisons were made between infants with sPDA who were treated and not treated. Results: During November 2017-2018, 227 infants from 23 to 31(+6) weeks' gestational age (GA) were admitted; 50 (22%) infants were diagnosed with PDA, 32 treated with PCM, overall treatment rate of 32/227 (14%). Successful therapy was noted in 23/32 (72%) and was higher when treated at 26 weeks GA (62.5 versus 100%, p = .07) and BW >1000 g (65.4 versus 100%, p = .14). Univariate analysis noted statistical significance only for GA. Eighteen infants were managed conservatively. Treated infants had a lower GA and BW, higher composite ECHO score (14.4 +/- 0.5 versus 19 +/- 0.4, p < .001). Conclusions: Composite scoring helped reduce exposure, and focus more on infants with lower GA and BW with greater shunt severity.