Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor's Office Tower, 2200 Children's Way, Nashville 37232-9544, TN.
Mildred T. Stahlman Division of Neonatology, Vanderbilt University Medical Center, 11111 Doctor's Office Tower, 2200 Children's Way, Nashville 37232-9544, TN; Center for Health Services Research, Vanderbilt Center for Child Health Policy, Nashville, TN; Department of Health Policy, Vanderbilt University Medical Center, Nashville, TN.
Semin Perinatol. 2018 Jun;42(4):253-261. doi: 10.1053/j.semperi.2018.05.008. Epub 2018 May 22.
Optimal management of patent ductus arteriosus (PDA) is unclear. One treatment, surgical ligation, is associated with adverse outcomes. We reviewed data from the Kids' Inpatient Database (2000-2012) to determine if PDA ligation rates: (1) changed over time, (2) varied geographically, or (3) influenced surgical complication rates. In 2012, 47,900 infants <1500g birth weight were born in the United States, including 2,800 undergoing PDA ligation (5.9%). Ligation was more likely in infants <1000g (85.9% vs. 46.2%), and associated with necrotizing enterocolitis (59.2% vs. 37.5%), BPD (54.6% vs. 15.2%), severe intraventricular hemorrhage (16.4% vs. 5.3%), and hospital transfer (37.6% vs. 16.4%). Ligation rates peaked in 2006 at 87.4 per 1000 hospital births, dropping to 58.8 in 2012, and were consistently higher in Western states. Infants undergoing ligation were more likely to experience comorbidities. Rates of ligation-associated vocal cord paralysis increased over time (1.2-3.9%); however, mortality decreased (12.4-6.5%). Thus, PDA ligation has become less frequent, although infants being ligated are smaller and more medically complex. Despite increase in some complications, mortality rates improved perhaps reflecting advances in care.
动脉导管未闭（PDA）的最佳治疗方法尚不清楚。一种治疗方法，即手术结扎，与不良结局相关。我们回顾了儿童住院数据库（2000-2012 年）的数据，以确定 PDA 结扎率是否：（1）随时间变化，（2）存在地域差异，或（3）影响手术并发症发生率。2012 年，美国出生体重<1500g 的婴儿有 47900 名，其中 2800 名接受了 PDA 结扎（5.9%）。结扎更可能发生在体重<1000g 的婴儿中（85.9%比 46.2%），并与坏死性小肠结肠炎（59.2%比 37.5%）、BPD（54.6%比 15.2%）、严重脑室出血（16.4%比 5.3%）和医院转院（37.6%比 16.4%）相关。结扎率在 2006 年达到高峰，为每 1000 例医院分娩 87.4 例，2012 年降至 58.8 例，且在西部各州一直较高。接受结扎的婴儿更有可能出现合并症。结扎相关声带麻痹的发生率随时间增加（1.2-3.9%）；然而，死亡率下降（12.4-6.5%）。因此，PDA 结扎的频率降低，尽管结扎的婴儿更小，病情更复杂。尽管某些并发症有所增加，但死亡率的改善可能反映了治疗的进步。
