Lee Lleona C L, Tillett Angela, Tulloh Robert, Yates Robert, Kelsall Wilf
NICU Box 226, Addenbrookes NHS Trust, Hills Road, Cambridge, CB2 2QQ, UK.
BMC Pediatr. 2006 May 11;6:15. doi: 10.1186/1471-2431-6-15.
The patent ductus arteriosus (PDA) is an important problem in premature infants. Surgical PDA ligation is usually only be considered when medical treatment has either failed or was contraindicated. The aims of our study were to determine the mortality and morbidity following patent ductus arteriosus ligation in premature infants, and whether prostaglandin synthetase inhibitor (PSI) use prior to ligation affects outcome.
A retrospective case note review study to determine the outcome of premature infants undergoing patent ductus arteriosus ligation in one tertiary neonatal intensive care unit and two paediatric cardiothoracic centres.
We had follow-up data on 87 infants. Cumulative mortality rates at 7 days, 30 days and at hospital discharge were 2%, 8% and 20% respectively. The incidence of chronic lung disease, intraventricular haemorrhage, necrotising enterocolitis and retinopathy of prematurity were 77%, 39%, 26% and 28% respectively. There was no difference in mortality, incidence of chronic lung disease or duration of oxygen dependence between those who had and those who had not received a PSI prior to surgical ligation. In those who had received 2 or more courses of PSI prior to surgical ligation, there was a trend to increase in the duration of oxygen therapy and chronic lung disease, but no difference in mortality.
This study shows that patent ductus arteriosus ligation is a relatively safe procedure (30 day survival 92%) but there is substantial late mortality and a high incidence of morbidity in the survivors. 2 or more courses of PSI prior to surgical ligation trends to increased oxygen dependence and chronic lung disease. This high risk population requires careful follow-up. A definitive prospective cohort study is lacking.
动脉导管未闭（PDA）是早产儿的一个重要问题。通常只有在药物治疗失败或存在禁忌证时才考虑进行手术结扎动脉导管。我们研究的目的是确定早产儿动脉导管未闭结扎术后的死亡率和发病率，以及结扎术前使用前列腺素合成酶抑制剂（PSI）是否会影响预后。
一项回顾性病例记录审查研究，以确定在一个三级新生儿重症监护病房和两个小儿心胸中心接受动脉导管未闭结扎术的早产儿的预后。
我们有87例婴儿的随访数据。7天、30天和出院时的累积死亡率分别为2%、8%和20%。慢性肺病、脑室内出血、坏死性小肠结肠炎和早产儿视网膜病变的发生率分别为77%、39%、26%和28%。手术结扎前接受和未接受PSI的患者在死亡率、慢性肺病发生率或氧依赖持续时间方面没有差异。在手术结扎前接受2个或更多疗程PSI的患者中，氧疗持续时间和慢性肺病有增加的趋势，但死亡率没有差异。
本研究表明，动脉导管未闭结扎术是一种相对安全的手术（30天生存率为92%），但幸存者有较高的晚期死亡率和发病率。手术结扎前2个或更多疗程的PSI会增加氧依赖和慢性肺病的风险。这一高风险人群需要密切随访。目前缺乏确定性的前瞻性队列研究。
