Clyman Ronald, Cassady George, Kirklin James K, Collins Monica, Philips Joseph B
Cardiovascular Research Institute and Department of Pediatrics, University of California, San Francisco, CA 94143-0544, USA.
J Pediatr. 2009 Jun;154(6):873-6. doi: 10.1016/j.jpeds.2009.01.005. Epub 2009 Mar 25.
To reexamine data from a randomized controlled trial of prophylactic ductus ligation to determine whether ligation contributes directly to the development of bronchopulmonary dysplasia (BPD) in extremely low birth weight infants.
The control group underwent ligation only if they had development of a symptomatic patent ductus arteriosus (PDA). The Prophylactic Ligation group underwent ligation within 24 hours of birth regardless of the presence or absence of symptoms of a PDA. We hypothesized that the incidence of BPD would be higher in the prophylactic ligation group because more ligations were performed than in the control group.
Prophylactic ligation significantly increased the incidence of BPD (defined as a supplemental oxygen requirement at 36 weeks postmenstrual age) and the incidence of mechanical ventilation at 36 weeks. The groups were statistically similar in gestation, sex, race, fluid administration, intraventricular hemorrhage, pulmonary air leaks, and survival to 36 weeks. The lower incidence of BPD in the control group occurred despite the fact that the incidence of necrotizing enterocolitis (a known risk factor for BPD) was significantly elevated in the control group. Only infants who had previously undergone a PDA ligation had development of BPD in the control group.
Prophylactic ligation, while eliminating the PDA, increases the risk for BPD.
重新审视一项预防性动脉导管结扎随机对照试验的数据，以确定结扎是否直接导致极低出生体重儿发生支气管肺发育不良（BPD）。
对照组仅在出现有症状的动脉导管未闭（PDA）时才进行结扎。预防性结扎组在出生后24小时内进行结扎，无论是否存在PDA症状。我们假设预防性结扎组中BPD的发生率会更高，因为与对照组相比，进行的结扎手术更多。
预防性结扎显著增加了BPD的发生率（定义为孕龄36周时需要补充氧气）以及36周时机械通气的发生率。两组在孕周、性别、种族、液体输入、脑室内出血、肺空气泄漏和存活至36周方面在统计学上相似。尽管对照组中坏死性小肠结肠炎（一种已知的BPD危险因素）的发生率显著升高，但对照组中BPD的发生率较低。对照组中只有先前接受过PDA结扎的婴儿发生了BPD。
预防性结扎虽然消除了PDA，但增加了发生BPD的风险。
