Albayrak Gökhan, Aykut Koray, Karacelik Mustafa, Soylar Ramazan, Karaarslan Kemal, Abud Burçin, Guzeloglu Mehmet, Hazan Eyup
Department of Cardiovascular Surgery, Izmir University, Medical Park Hospital, Izmir, Turkey.
Department of Cardiovascular Surgery, Dr. Behcet Uz Children Hospital, Izmir, Turkey.
Open J Cardiovasc Surg. 2014 Aug 17;7:1-4. doi: 10.4137/OJCS.S16156. eCollection 2014.
Patent ductus arteriosus (PDA) is commonly seen in premature infants with low birth weights (LBW). It is a condition that has high mortality and morbidity rates. Early closure of the ductus arteriosus may require surgery or medical treatment. However, the decision of first medical approach for symptomatic PDA closure is still debated. In this study, we compared the surgical and medical treatments for the closure of PDA in premature LBW infants.
This study included 27 premature infants whose birth weights were lower than 1500 g, who were born in the period between 2011 and 2013 and had symptomatic PDA. Patients were separated into two groups: groups A and B. Group A included patients whose PDAs were closed with medical treatment (n = 16), and group B included patients who had undergone surgical operations for PDA closure (n = 11).
There were no statistically significant differences between groups A and B when the groups were compared in terms of birth weight, gestational age, respiratory distress syndrome (RDS), necrotizing enterocolitis (NEC), sepsis, intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP), and pneumothorax. Although the mortality rate was determined to be lower in group B (2 out of 11, 18.1%) than in group A (7 out of 16, 43.7%), no statistically significant difference was found between the two groups. A statistically significant increase was determined in the incidence of kidney function loss in patient group that received Ibuprofen, a medical treatment, in comparison to the patients who had surgery.
In conclusion, surgery is a safe method to repair PDA in premature LBW infants. Although there is no remarkable difference between surgery and medical treatment, we suggest that a surgical approach may be used as a first choice to repair PDA considering the lower rate of mortality and morbidity and higher rate of closure compared to medical treatment.
动脉导管未闭（PDA）在低出生体重（LBW）的早产儿中很常见。这是一种死亡率和发病率都很高的病症。动脉导管的早期闭合可能需要手术或药物治疗。然而，对于有症状的PDA闭合的首选药物治疗方法仍存在争议。在本研究中，我们比较了早产LBW婴儿PDA闭合的手术治疗和药物治疗。
本研究纳入了27例出生体重低于1500g、于2011年至2013年期间出生且患有症状性PDA的早产儿。患者被分为两组：A组和B组。A组包括接受药物治疗使PDA闭合的患者（n = 16），B组包括接受PDA闭合手术的患者（n = 11）。
在出生体重、胎龄、呼吸窘迫综合征（RDS）、坏死性小肠结肠炎（NEC）、败血症、脑室内出血（IVH）、早产儿视网膜病变（ROP）和气胸方面比较两组时，A组和B组之间没有统计学上的显著差异。虽然确定B组的死亡率（11例中有2例，18.1%）低于A组（16例中有7例，43.7%），但两组之间没有发现统计学上的显著差异。与接受手术的患者相比，接受药物治疗布洛芬的患者组肾功能丧失的发生率有统计学上的显著增加。
总之，手术是修复早产LBW婴儿PDA的一种安全方法。虽然手术和药物治疗之间没有显著差异，但考虑到与药物治疗相比，手术的死亡率和发病率较低且闭合率较高，我们建议手术方法可作为修复PDA的首选。
