Department of Neonatal Medicine, The Royal Hospital for Sick Children, Yorkhill, Glasgow, UK.
Arch Dis Child Fetal Neonatal Ed. 2012 Jan;97(1):F39-44. doi: 10.1136/adc.2010.206052. Epub 2011 Aug 17.
To determine morbidity, mortality and associated risk factors following patent ductus arteriosus (PDA) ligation in premature infants.
Retrospective case note audit of premature infants referred to a national paediatric cardiothoracic surgical service (2001-2007) with univariate and multivariate analysis of potential risk factors for mortality and morbidity.
125 infants were enrolled (median gestational age 26 weeks (IQR 25-27 weeks), median birth weight 840 g (IQR 730-1035 g)). Referral characteristics were median LA:Ao 1.8 (IQR 1.5-2.0), 80% ventilated, 18.4% continuous positive airway pressure, 70% diuretics and 58% prior treatment with cyclooxygenase inhibitors (COIs). Median age at PDA ligation was 31 days (IQR 25-41 days). Postoperative characteristics were median time to extubation 5 days (IQR 3-10 days), 36.0% corticosteroids, 46.8% domiciliary oxygen and 4.8% vocal cord palsy. The 30-day and 1-year mortality rates were 4.8% and 12.8%, respectively, with neurodisability in 32% of survivors. All deaths occurred in the ventilated group and were mainly attributable to bronchopulmonary dysplasia (BPD). Gestation and fractional inspired oxygen (FiO(2))>60% were significantly associated with 30-day mortality. FiO(2), ventilation, lack of prior COIs and postoperative corticosteroids were significantly associated with 1-year mortality. Preoperative FiO(2)>40% and lack of prior COIs retained independent significance for death at 1 year.
PDA ligation is well tolerated, with evidence of early benefit. The incidence of neurodisability or death from BPD at 1 year remains high. Increasing preoperative FiO(2) and lack of prior treatment with COIs are associated with increased mortality at 1 year.
确定动脉导管未闭（PDA）结扎术后早产儿的发病率、死亡率和相关危险因素。
回顾性分析 2001 年至 2007 年期间转诊至国家儿科心胸外科服务机构的早产儿病例记录（单变量和多变量分析潜在死亡和发病的危险因素）。
共纳入 125 名婴儿（中位胎龄 26 周（IQR 25-27 周），中位出生体重 840g（IQR 730-1035g））。转诊特征为 LA:Ao 中位数 1.8（IQR 1.5-2.0），80%使用呼吸机，18.4%持续气道正压通气，70%使用利尿剂，58%曾使用环氧化酶抑制剂（COI）治疗。PDA 结扎的中位年龄为 31 天（IQR 25-41 天）。术后特征为中位拔管时间为 5 天（IQR 3-10 天），36.0%使用皮质激素，46.8%家庭吸氧，4.8%声带麻痹。30 天和 1 年死亡率分别为 4.8%和 12.8%，幸存者中有 32%存在神经发育障碍。所有死亡均发生在使用呼吸机的患儿中，主要与支气管肺发育不良（BPD）有关。胎龄和吸入氧分数（FiO（2））>60%与 30 天死亡率显著相关。FiO（2）、通气、无先前 COI 治疗和术后皮质激素与 1 年死亡率显著相关。术前 FiO（2）>40%和无先前 COI 治疗保留了 1 年死亡的独立意义。
PDA 结扎术耐受性良好，早期获益证据确凿。1 年时神经发育障碍或 BPD 死亡的发生率仍然很高。术前 FiO（2）增加和缺乏先前 COI 治疗与 1 年死亡率增加相关。
