早产儿动脉导管未闭的消炎痛治疗

目的 探讨消炎痛治疗早产儿动脉导管未闭(PDA)的疗效。方法 对确诊为早产儿PDA的20例患儿。以消炎痛每次0．1～0．3mg／kg鼻饲给药，每12小时一次。共用3次为一疗程。结果：第一个疗程PDA闭合为16例。第二个疗程PDA闭合1例．3例未闭合。结论 消炎痛关闭早产儿PDA成功率高，给药时间早,效果更佳。     

早产儿动脉导管未闭的消炎痛治疗

目的　 探讨消炎痛治疗早产儿动脉导管未闭 (PDA)的疗效。 方法 　对确诊为早产儿PDA的 2 0例患儿 ,以消炎痛每次 0 1～ 0 3mg/kg鼻饲给药 ,每 12小时一次 ,共用 3次为一疗程。结果 :第一个疗程PDA闭合为 16例 ,第二个疗程PDA闭合1例 ,3例未闭合。 结论 　消炎痛关闭早产儿PDA成功率高 ,给药时间早 ,效果更佳。     

低体重早产儿动脉导管未闭治疗进展

动脉导管未闭是一种新生儿常见疾病。在早产儿,尤其是低体重儿中其发病率更高。如未及时治疗,往往会导致新生儿颅内出血、呼吸窘迫综合征、慢性肺疾病等严重并发症。目前临床上有药物治疗、手术治疗、介入治疗及对症治疗,该文对低体重早产儿动脉导管未闭治疗的进展作一综述。     

早产儿动脉导管未闭的诊疗进展

动脉导管未闭(PDA)是早产儿最常见的先天性心脏病,若未及时诊断与处理,常可诱发或促进充血性心衰、慢性肺疾病、颅内出血和坏死性小肠结肠炎(NEC)等的发生发展,是影响早产儿存活率和后遗症发生率的主要原因之一。近年来,随着对早产儿PDA的深入研究,一些新的诊疗技术日趋成熟,在临床上应用并取得较好的效果。     

口服美林对早产儿动脉导管未闭的疗效观察

目的　口服美林与消炎痛对早产儿动脉导管未闭 (PDA)的疗效和副作用进行对比分析 ,以便寻找更好的治疗方法。方法　将 35例早产儿PDA患儿随机分为 2组 :A组 17例给予口服美林治疗 ,B组 18例口服消炎痛治疗。结果　美林 16例PDA(94 1% )闭合 ,消炎痛组 10例 (6 1 1% )闭合 ,美林组PDA闭合率明显高于消炎痛组 (P <0 0 2 5 )。在副作用方面 ,美林组仅 1例 (5 9% )有少量胃出血 ,而消炎痛组 10例 (5 5 6 % )分别并发了坏死性小肠结肠炎 (2例 ) ,胃出血(2例 ) ,IVH 1例 ,肾功能损害 (4例 ) ,低血糖、低钠血症 (1例 ) ;明显高于美林组 (P <0 0 0 5 )。结论　口服美林治疗早产儿PDA不仅疗效优于消炎痛 ,而且副作用少 ,安全系数高     

早产儿动脉导管未闭发病率及消炎痛治疗10年总结

目的探讨早产儿动脉导管未闭的发病率及消炎痛的治疗效果。方法根据早产儿及患动脉导管未闭例数计算早产儿动脉导管未闭的发病率。观察早产儿动脉导管未闭发病率与早产儿体重及胎龄的关系，探讨消炎痛对早产儿动脉导管未闭患儿的治疗效果。结果早产儿动脉导管未闭的发病率为５．０６％（６０／１１８５），出生体重≤１５００克者，其发病率为６．５４％（１０／１５５），～２０００克者为５．２５％（２７／５１４），～２５００克者为４．８８％（１９／３８９），≥２５００克者为３．１５％（４／１２７），各组发病率有显著性差异（ｘ２＝６４．８５，Ｐ＜０．０１）。早产儿动脉导管未闻发病率与胎龄无关（ｘ２＝０．３４４，Ｐ＞０．０５）。消炎痛治疗４１例，痊愈３１例（７５．８１％）。≤１５００克、２０００克、２５００克及≥２５００克等组消炎病治愈率分别１００％、９０．９１％、５３．８４％和０（ｘ２＝１３．６２，Ｐ＜０．０５），治愈率与胎龄无关。结论早产儿动脉导管未闻的发病率及消炎痛对其治愈率随出生体重增加而降低，两者与胎龄无关。     

胎龄<28周早产儿动脉导管未闭的治疗进展

动脉导管未闭(PDA)是早产儿常见疾病,目前早产儿PDA的自然发展过程仍未完全明确,PDA发生的有些高危因素仍存在争议,对PDA是否进行药物、手术干预,以及何时进行药物、手术干预仍存在争议。尽管已经有相当多的证据证实动脉导管持续开放可能有害,但目前尚缺乏关闭导管治疗方案的远期益处或害处的相关证据。大多数临床试验旨在评估短期导管开放对患儿的影响。目前尚无评估动脉导管持续开放对早产儿死亡率及并发症影响的临床试验。近年来PDA治疗上最大的变化是减少对PDA的治疗。该文重点总结胎龄28周早产儿PDA的治疗策略。     

布洛芬口服治疗动脉导管未闭早产儿的疗效及安全性

目的观察布洛芬治疗动脉导管未闭(PDA)早产儿的疗效及安全性。方法早产儿PDA 43例,根据有无并其他心脏畸形,分为单纯PDA组及复合型PDA组,单纯PDA组根据出生体质量分为≥1500 g及<1500 g组。均予以布洛芬口服治疗,观察布洛芬的疗效及其不良反应。结果单纯组PDA关闭率为80.78%,复合组关闭率为47.06%,两组有显著差异(χ2=5.981 P<0.01);体质量≥1500 g组关闭率为80.0%,<1500 g组关闭率为81.81%,两组无显著差异(χ2=0.38 P>0.05)。43例仅1例出现胃潴留,未观察到其他不良反应。结论布洛芬口服治疗早产儿单纯PDA疗效好,对复合型PDA也有一定效果。     

早产儿动脉导管开放的处理

动脉导管开放(PDA)是早产儿常见病症,导致早产儿血流动力学不稳定,严重者可危及生命,应积极处理.药物关闭PDA仍是最有效、方便和经济的治疗方法,吲哚美辛一直是内科保守治疗的主要用药,PDA关闭率为46%～89%,但吲哚美辛有效血药浓度安全范围较窄,且可导致肾功能障碍、颅内出血、坏死性小肠结肠炎和肠穿孔等不良反应.近年国外采用布洛芬治疗早产儿PDA,取得较好疗效,关闭率为73.0%～95.5%,且对肾脏、脑及消化道血流动力学影响显著减少.药物治疗无效且严重影响心肺功能者可选择手术治疗.     

儿童动脉导管未闭治疗进展

动脉导管未闭是儿童常见先天性心脏病,及时有效治疗可防止肺炎、心力衰竭、感染性心内膜炎、肺动脉高压等并发症的发生.治疗方法包括药物治疗、经导管介入治疗和手术治疗.目前绝大部分动脉导管未闭通过介入封堵可获治愈.     

氨基末端脑钠肽前体预测早产儿症状性动脉导管未闭的价值

目的 探讨氨基末端脑钠肽前体(NT-proBNP)预测早产儿症状性动脉导管未闭(sPDA)的价值。方法 选择2014年6月至2015年4月出生、胎龄≤32周、48 h内超声心动图确定存在动脉导管的早产儿为研究对象,监测其临床表现,于生后3 d及5 d检测血清NT-proBNP水平并行超声心动图检查,根据患儿临床表现、超声心动图结果分为sPDA组及非症状性动脉导管未闭(asPDA)组,分析血清NT-proBNP水平与超声指标的关系,比较两组间相同日龄血清NT-proBNP水平,ROC曲线确定血清NT-proBNP水平预测sPDA的敏感性、特异性。结果 共69例早产儿纳入研究,其中sPDA组13例,asPDA组56例。血清NT-proBNP水平与动脉导管管径、左房内径与主动脉根部内径比值(LA/AO)呈正相关关系(分别r=0.856、0.713,均 PPCI:0.892~1.000,PCI:0.848~1.000,P结论 NT-proBNP可能是动脉导管分流量的量化指标;生后3 d 及5 d血清NT-proBNP水平的检测均有助于早期预测sPDA。     

Clinical and echocardiographic diagnosis of patent ductus arteriosus in premature neonates

The ductus arteriosus frequently fails to close in premature neonates. Considerable difference in opinion exists around what signifies a hemodynamically significant patent ductus arteriosus (PDA) and how reliable clinical signs are in determining the degree of the left-to-right shunting. Although reliance on clinical signs alone could delay the diagnosis of a PDA, there is insufficient evidence to suggest that early treatment improves outcome. Echocardiography is often used as the gold standard for diagnosing a PDA. A combination of echocardiographic measurements may assist in the early diagnosis of a PDA with a hemodynamically significant degree of left-to-right shunting, especially in extremely premature babies, where closure can be significantly delayed. Decision to treat PDA should be based on a combination of clinical signs and echocardiographic parameters. Monitoring B-type natriuretic peptide may be useful in the diagnosing neonates with symptomatic PDA.     

Indomethacin and cerebral blood flow in premature infants treated for patent ductus arteriosus

Central blood flow (CBF) was estimated by an intravenous 133-xenon technique in six preterm infants before and after administration of indomethacin for closure of patent ductus arteriosus. CBF fell in all infants (range 12%–40%), the mean fall was 24% (P<0.005). Though none of the infants showed signs of impaired cerebral function during or following the injections, the results do not indicate whether or not the use of indomethacin is a potential hazard.Abbreviations PDA patent ductus arteriosus - CBF cerebral blood flow - PaCO₂ arterial carbon dioxide tension - MAP mean arterial blood pressure     

Pulmonary effects of closure of patent ductus arteriosus in premature infants with severe respiratory distress syndrome

The pulmonary effects of closure of a patent ductus arteriosus (PDA) were investigated in 11 premature infants with severe respiratory distress syndrome. Successful closure of a PDA did not improve the short-term severity of pulmonary disease (24 and 48 h after treatment) as judged by the arterial/alveolar oxygen tension ratio or the amount of ventilatory support. Also, pulmonary mechanics measured 24 h before, 24 and 48 h after treatment, were not statistically different.Conclusion Infants with severe respiratory disease requiring high ventilation pressure and high oxygen concentration, where structural changes in the lungs are already established, will rarely show short-term improvement in pulmonary disease as a result of closure of a PDA. The overall clinical condition may, however, improve as a result of reduced cardiovascular strain. Earlier treatment of a PDA could reduce the ventilation period and the possible risk of developing chronic lung disease.     

Pharmacokinetics of intra-arterial indomethacin treatment for patent ductus arteriosus

Summary We present pharmacokinetic data of prolonged, intra-arterial indomethacin treatment (i.e. induction plus maintenance dose) for symptomatic patent ductus arteriosus (sPDA) in 26 ventilated premature infants. sPDA was assessed by two-dimensional and pulsed Doppler echocardiography. Permanent ductal closure occurred in 20 (76%) infants. Plasma levels of indomethacin were 1.18±0.74; 1.8±1.0; 1.51±0.93 and 1.25±0.98 g/ml (mean±SD) at 12, 24, 48 and 72 h after initial dose administration. All except one patient who responded with ductal closure, showed plasma levels above 0.25 g/ml throughout the 3 day treatment period and no case of sPDA reopening was noted. Although target concentrations over time were not defined, the data indicate that the maintenance levels measured were within the therapeutic range. A negative correlation was found for plasma drug levels and postnatal age (r=0.52;P<0.01). Volume of drug distribution was 0.23±0.18l/kg, total clearance 0.1±0.11 ml/min and elimination constant 0.06±0.05h^–1 (mean±SD). The great variation in pharmacokinetic data reflects the heterogeneity of the population studied with respect to extracellular fluid space, cardiovascular status, serum protein and other parameters.     

Echocardiographic prediction of patent ductus arteriosus in need of therapeutic intervention

Aim: To evaluate the efficacy of various echocardiographic markers in predicting a patent ductus arteriosus (PDA) in need of treatment. Methods: Forty‐five preterm infants with a mean (SD) gestational age of 27.7 (1.9) weeks underwent echocardiography at a postnatal age of 24 ± 6 and 72 ± 6 h. Four echocardiographic markers were studied: ductus diameter, ductal flow Doppler curves, the left atrial to aortic root (LA/Ao) ratio and Doppler pixels representing ductal shunting. Results: Twenty‐eight infants had a PDA with a detectable left‐to‐right shunt. Of these, 12 (43%) were treated for a shunt through the PDA. Ductal diameter was the most accurate echocardiographic marker when it came to predicting a significant shunt, with a sensitivity of 89%, a specificity of 70%, a positive likelihood ratio of 2.97 and a negative likelihood ratio of 0.16 at the age of 72 h. The efficacy of the method at 72 h of age was 84%. The corresponding efficacy of the pulsatile Doppler curve was 72%, percentage of green colour pixels 63% and the LA/Ao ratio 53%. Conclusion: Ductus diameter appears to be the most important variable in determining the need for therapeutic intervention for PDA in preterm infants.