前列腺素E1新制剂在新生儿先心病术前的疗效

目的探讨前列腺素E1(PGE1)新型制剂在新生儿动脉导管依赖型先天性心脏病手术前的应用和价值.方法通过观察本院NICU 3年内收治的重症先天性心脏病患儿共47例,分析不同先心病类型、不同开始用药时间,心脏术前应用PGE1静脉输注维持动脉导管开放的疗效和副作用.结果在三种不同类型先心病中的有效性为右室流出道梗阻型组19/23(82.61%);左心病变组 3/6(50.00%);完全性大血管错位组13/18(72.22%).三组PGE1应用的有效性无统计学差异(P>0.05).不同用药时间的有效率<7 d者占81.48%(22/27),7 ～ 14 d者占66.67%(6/9),>2周者占63.64%(7/11).副作用主要为发热(14/47),部分出现呼吸暂停/伴心率下降(10/47),仅个别需要辅助通气.结论前列腺素E1新型制剂在新生儿重症动脉导管依赖先天性心脏病手术前的应用,能有效地维持动脉导管开放,为准备心脏外科手术争取时间;其副作用一般经密切观察、对症处理或酌情减量、停药后均能控制,在新生儿中应用是安全可行的.

Preoperative Application of Prostaglandin E1 in Severe Neonatal Congenital Heart Disease

ObjectiveTo study the therapeutic effect of prostaglandin E_(1 )(PGE_(1)) in preoperative neonatal ductus-dependent congenital heart diseases.MethodsForty-seven neonates with severe congenital heart disease were enrolled into the NICU during Jan 2000 to Dec 2003. The therapeutic effect and side effects of prostaglandin E_(1) infusion were analyzed in different types of congenital heart diseases, different time intervals of PGE_(1 )infusion prior to operation, and effects of retaining patent ductus arteriosus.ResultsThe effective rates of PGE_(1) in 3 groups were (82.61%)(19/23) in right ventricular outflow tract obstruction group, 50.00%(3/6) in left heart lesion group, and (72.22%)(13/18) in transposition of great arteries (TGA) group. The effective rate in different initiating time intervals prior to operation was 81.48% (22/27) in those within 7 d after birth, 66.67% (6/9) among 7 to 14 d, and 63.64%(7/11) beyond two weeks of life. The side effects in all patients were studied: 14 had fever; 10 had apnea, 3 bradycadia and 2 fever.ConclusionApplication of prostaglandin E_(1) in ductus-dependent congenital heart (diseases) in preoperative neonates can effectively retain patent ductus arteriosus after birth and improve hypoxemia in the course of preparation for cardiac operation. The side effects were followed and treated. The dosage of PGE_(1 )should be decreased or stopped when the side effect appears. It is safe to use PGE_(1 )in preoperative neonates.