共识指南实施后动脉导管未闭治疗频率降低：15 年经验。
Decrease in the frequency of treatment for patent ductus arteriosus after implementation of consensus guidelines: a 15-year experience.
机构信息
Division of Neonatal-Perinatal Medicine, UT Southwestern Medical Center, Dallas, TX, USA.
Parkland Health and Hospital System, Dallas, TX, USA.
出版信息
J Perinatol. 2019 Nov;39(11):1569-1576. doi: 10.1038/s41372-019-0432-8. Epub 2019 Jul 23.
BACKGROUND
Patent ductus arteriosus (PDA) management varies widely among neonatologists.
LOCAL PROBLEM
Lack of institution-specific evidence-based guidelines for therapeutic closure of PDA.
METHODS
Quality improvement project among infants <30 weeks gestational age (GA) designed to determine whether the odds of therapy for closing the PDA, adjusted for GA, decreased after implementing evidence-based guidelines.
INTERVENTION
Implementation of guidelines with conservative approach to PDA management.
RESULTS
The frequency of PDA treatment decreased from 446/1125 (40%) in Epoch 1 to 96/482 (20%) in Epoch 2. PDA treatment was more frequent in neonates 23-26 weeks GA than those of 27-29 weeks GA (43% vs. 28%, respectively). Among 542 infants receiving indomethacin for PDA, 25% had subsequent ligation; the odds of ligation after indomethacin were lower in neonates 27-29 weeks GA and decreased during Epoch 2.
CONCLUSIONS
The frequency of medical and surgical treatment for therapeutic closure of PDA decreased after implementing evidence-based treatment guidelines.
背景
动脉导管未闭（PDA）的管理在新生儿科医生中差异很大。
本地问题
缺乏针对特定机构的、基于证据的 PDA 治疗闭合指南。
方法
在<30 周胎龄（GA）的婴儿中开展质量改进项目，旨在确定在实施基于证据的指南后，调整 GA 后，PDA 治疗的可能性是否降低。
干预措施
实施 PDA 管理的保守方法指南。
结果
PDA 治疗的频率从第 1 阶段的 1125 例中的 446 例（40%）降至第 2 阶段的 482 例中的 96 例（20%）。23-26 周 GA 的新生儿比 27-29 周 GA 的新生儿更频繁地接受 PDA 治疗（分别为 43%和 28%）。在接受吲哚美辛治疗 PDA 的 542 名婴儿中，有 25%随后进行了结扎；27-29 周 GA 的新生儿进行结扎的可能性较低，并且在第 2 阶段期间有所下降。
结论
实施基于证据的治疗指南后，PDA 治疗的药物和手术治疗频率降低。
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