Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost?
Patent ductus arteriosus ligation in premature infants: who really benefits, and at what cost?
复制标题
DOI：
10.1016/j.jpedsurg.2006.09.040
复制
发表时间：
2007-01-01
影响因子：
2.4
通讯作者：
Phillips, J. Duncan
中科院分区：
文献类型：
--
作者：
Raval, Mehul V.;Laughon, Matthew M.;Phillips, J. Duncan
目的：动脉导管未闭(PDA)结扎术治疗早产儿手术并发症和死亡率低。结扎术的目标包括迅速改善心肺功能衰竭，迅速脱离机械通气；降低延长机械通气和随后的慢性肺部疾病(CLD)的风险；以及存活到出院。这项研究旨在检查结扎后的真实发病率，并阐明哪些术前因素可以预测有利的结果。方法：对1992年1月1日至2004年1月1日期间经机构审查委员会批准的197例胎龄小于38周的婴儿进行经开胸PDA结扎术的回顾。慢性肺病定义为36周时需要补充氧气纠正GA。结果：胎龄平均27周(23~35周)，出生体重957 g(440~3170 g)，出生16天(1~132 d)结扎。手术时间为50.5分钟(13~150分钟)。术后平均拔管时间27天，脱氧60天，出院84天。早期拔管(在结扎后10天内)只有54例(30%)。只有44人(22%)在没有CLD的情况下存活到出院。40名患者(20%)死亡，其中呼吸衰竭是最常见的原因(70%)。总体而言，早期拔管、无CLD存活和出院存活与较大的GA和出生体重、较高的Apgar评分、较大的手术年龄和体重、术前无脑室出血、缺乏呼吸机依赖性和较低的呼吸机设置有关(P<；0.05)。术前消炎痛的使用量和持续时间、胸部X光检查结果和超声心动图对导管大小的评估并不能预测良好的结果(均P>；0.05)。结论：目前在我所接受PDA结扎术的大多数早产儿并没有经历预期的心肺状况的快速改善，而是继续发展为CLD。很少有术前变量(包括放射学和超声心动图评估)能明确预测结果。(C)2007 Elsevier Inc.保留所有权利。
Purpose: Patent ductus arteriosus (PDA) ligation in premature infants has been shown to have low Surgical morbidity and mortality. Ligation goals include prompt improvement in cardiorespiratory failure, with rapid wean from mechanical ventilation; less risk of prolonged mechanical ventilation and Subsequent chronic lung disease (CLD); and survival to discharge. This study was designed to examine true morbidity after ligation and elucidate which preoperative factors might predict favorable outcomes.Methods: Institutional review board-approved retrospective review of 197 infants less than 38 weeks of gestational age (GA), undergoing PDA ligation via thoracotomy between January 1, 1992, and January 1, 2004. Chronic lung disease defined as need for supplemental oxygen at 36 weeks corrected GA. Student t and 2 tests were used.Results: Mean GA was 27 weeks (range, 23-35 weeks), birth weight was 957 g (range, 440-3170 g); infants underwent ligation at 16 days of life (range, 1-132 days). Duration of surgery was 50.5 minutes (range, 13-150 minutes). Mean postoperative times were 27 days to extubation, 60 days to wean from supplemental oxygen, and 84 days to discharge. Early extubation (within 10 days of ligation) occurred in only 54 patients (30%). Only 44 (22%) Survived to discharge without CLD. Forty patients (20%) died, with respiratory failure the most common cause (70%). In general, early extubation, survival without CLD and survival to discharge were associated with greater GA and birth weight, higher Apgar scores, greater age and weight at surgery, no preoperative intraventricular hemorrhage, lack of ventilator dependence, and lower ventilator settings (P < .05). Preoperative amount and duration of indomethacin use, chest x-ray findings, and echocardiographic assessment of ductus size did not predict favorable outcomes (all P > .05).Conclusions: Most premature infants currently undergoing PDA ligation at our institution do not experience the anticipated rapid improvements in cardiorespiratory status and go on to develop CLD. Few preoperative variables (including radiographic and echocardiographic assessments) definitively predict outcomes. (c) 2007 Elsevier Inc. All rights reserved.