体重不足1500g早产儿动脉导管未闭的治疗

目的:通过对体重不足1500g的早产儿接受动脉导管早期结扎术者与仅接受消炎痛(indomethacin)治疗者的临床记录回顾性分析来寻找和确定更适当的治疗方法和方向。方法:我们把1996年7月至2003年12月治疗过的40例体重不足1500g的动脉导管未闭早产儿分为接受消炎痛的治疗者与未给予消炎痛而直接接受外科结扎者,对其结果做了比较分析。结果:消炎痛治疗者与外科手术者中的生存者与死亡者进行比较,二者在患者的体重,孕龄,伴随的心脏畸形,动脉导管的大小,消炎痛治疗并发症,机械辅助呼吸时间,ICU住院时间等均无显著性差异(P>0.05);对消炎痛治疗者与外科手术者进行比较,仅在并发症之间有显著性差异(P<0.05),即消炎痛治疗者有7例出现并发症(36.8%),而外科手术者的5例死亡也与患儿的术前状态密切相关。结论:对体重不足1500g的动脉导管未闭早产儿而言,因受消炎痛用药条件的限制、较高的并发症发生率和失败率,早期行动脉导管结扎术不失为有效的治疗手段。

The therapy of low birth weight premature infants with patent ductus arteriosus

Objective To suggest the optimal treatment method for patent ductus arteriosus(PDA) in the very low birth weight premature infants. Method 40 cases of very low birth weight premature infants(<1500g) with evidence of a hemodynamiclly compromise underwent indomethacin therapy(n=19) or early surgical ligation(n=21). They all in-hospitaled between July 1996 and December 2003, and their data were compared. Results Side effects thought to be related to indomethacin were noted in 7 patients(36.8%) and it had significant difference with the surgery group(P<0.05). Among the infants who underwent ligation, there was no complication related to the operation. 5 cases died in operation were associated with preexisting preoperative conditions including contraindications of indomethacin administration. Conclusion We conclude that early surgical ligation of the PDA in the very low birth weight infant who has restriction against administrating indomethacin can be a safe and effective procedure. However, long-term studies will be needed to confirm it later.