预防性手术结扎动脉导管未闭在极低出生体重儿中的作用：系统评价及对临床实践的启示
Role of prophylactic surgical ligation of patent ductus arteriosus in extremely low birth weight infants: Systematic review and implications for clinical practice.
作者信息
Mosalli Rafat, Alfaleh Khalid, Paes Bosco
机构信息
Departments of Pediatrics, Omm Al-Qura University, Mecca.
出版信息
Ann Pediatr Cardiol. 2009 Jul;2(2):120-6. doi: 10.4103/0974-2069.58313.
OBJECTIVES
To investigate the effectiveness and safety of prophylactic surgical ligation of patent ductus arteriosus (PDA) on mortality and morbidity of preterm infants weighing less than 1000 g at birth.
MATERIALS AND METHODS
The study conducted a systematic search of available database from 1996-2008. Retrieved articles were assessed for eligibility and data was abstracted independently by two reviewers. Decisions to include studies for review and the methodological quality of included studies were asssessed in duplicate based on predetermined criteria. No language restrictions were applied.
RESULTS
Only one eligible study that enrolled 84 extremely low birth weight infants was identified. Prophylactic surgical ligation of PDA resulted in a statistically significant reduction of severe stage II or III necrotizing enterocolitis, [RR 0.25, 95% CI (0.08, 0.83), P value 0.02, number needed to treat 5]. The study, however, found no statistically significant difference in mortality, intraventricular hemorrhage, bronchopulmonary dysplasia, and retinopathy of prematurity.
CONCLUSIONS
Current evidence does not support the use of prophylactic surgical ligation of PDA in the management of the preterm infants.
目的
探讨预防性手术结扎动脉导管未闭（PDA）对出生体重小于1000g的早产儿死亡率和发病率的有效性和安全性。
材料与方法
本研究对1996年至2008年的可用数据库进行了系统检索。对检索到的文章进行资格评估，数据由两名评审员独立提取。根据预定标准，对纳入综述的研究决策和纳入研究的方法学质量进行了重复评估。未应用语言限制。
结果
仅确定了一项符合条件的研究，该研究纳入了84例极低出生体重儿。预防性手术结扎PDA导致严重的II期或III期坏死性小肠结肠炎在统计学上显著减少，[相对危险度0.25，95%可信区间（0.08，0.83），P值0.02，需治疗人数5]。然而，该研究发现，在死亡率、脑室内出血、支气管肺发育不良和早产儿视网膜病变方面没有统计学上的显著差异。
结论
目前的证据不支持在早产儿管理中使用预防性手术结扎PDA。
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