米力农对动脉导管未闭结扎后新生儿的影响：一项回顾性全国数据库研究。
Effects of Milrinone on Neonates after Patent Ductus Arteriosus Ligation: A Retrospective Nationwide Database Study.
机构信息
Department of Pediatrics, The University of Tokyo Hospital, Tokyo, Japan.
Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
出版信息
Neonatology. 2023;120(6):751-759. doi: 10.1159/000533958. Epub 2023 Sep 27.
INTRODUCTION
Milrinone is administered after patent ductus arteriosus (PDA) ligation to prevent and treat postoperative hemodynamic instability (i.e., postligation cardiac syndrome). We aimed to explore the effectiveness of milrinone on in-hospital outcomes in infants who underwent PDA ligation using a nationwide inpatient database in Japan.
METHODS
Using the Japanese Diagnosis Procedure Combination database, we identified patients who received milrinone after PDA ligation (n = 428) in neonatal intensive care units between July 2010 and March 2021 and those who did not (n = 3,392). We conducted a 1:4 propensity score-matched analysis with adjustment for background characteristics (e.g., gestational age, birth weight, comorbidities, preoperative treatments, and hospital background) to compare morbidities (bronchopulmonary dysplasia, intraventricular hemorrhage, necrotizing enterocolitis, and retinopathy of prematurity), mortality, total hospitalization costs, and other outcomes. For sensitivity analysis, we performed an overlap propensity score-weighted analysis.
RESULTS
In-hospital morbidity, bronchopulmonary dysplasia, intraventricular hemorrhage, and necrotizing enterocolitis occurred in 58%, 48%, 9.5%, and 7.1% of patients, respectively; the in-hospital mortality was 5.4%. After 1:4 propensity score matching, no significant difference was observed regarding mortality (7.1 vs. 5.7%), in-hospital morbidity (55 vs. 50%), bronchopulmonary dysplasia (44 vs. 41%), intraventricular hemorrhage (7.8 vs. 9.1%), necrotizing enterocolitis (8.5 vs. 8.9%), retinopathy of prematurity (21 vs. 22%), or total hospitalization costs (median: approximately 86,000 vs. 82,000 US dollars) between milrinone users (n = 425) and nonusers (n = 1,698). Sensitivity analyses yielded consistent results.
CONCLUSIONS
Milrinone use after PDA ligation was not associated with improved in-hospital outcomes, such as mortality and morbidity.
简介
米力农在动脉导管未闭（PDA）结扎后使用，以预防和治疗术后血流动力学不稳定（即结扎后心脏综合征）。我们旨在使用日本全国住院患者数据库探索米力农对接受 PDA 结扎的婴儿住院期间结局的影响。
方法
使用日本诊断程序组合数据库，我们确定了 2010 年 7 月至 2021 年 3 月期间在新生儿重症监护病房接受 PDA 结扎后使用米力农的患者（n=428）和未使用米力农的患者（n=3392）。我们进行了 1:4 倾向评分匹配分析，调整了背景特征（例如，胎龄、出生体重、合并症、术前治疗和医院背景），以比较发病率（支气管肺发育不良、脑室内出血、坏死性小肠结肠炎和早产儿视网膜病变）、死亡率、总住院费用和其他结局。为了进行敏感性分析，我们进行了重叠倾向评分加权分析。
结果
住院期间发病率、支气管肺发育不良、脑室内出血和坏死性小肠结肠炎分别发生在 58%、48%、9.5%和 7.1%的患者中；住院死亡率为 5.4%。在进行 1:4 倾向评分匹配后，死亡率（7.1% vs. 5.7%）、住院发病率（55% vs. 50%）、支气管肺发育不良（44% vs. 41%）、脑室内出血（7.8% vs. 9.1%）、坏死性小肠结肠炎（8.5% vs. 8.9%）、早产儿视网膜病变（21% vs. 22%）或总住院费用（中位数：约 86000 美元 vs. 82000 美元）在米力农使用者（n=425）和非使用者（n=1698）之间无显著差异。敏感性分析得出了一致的结果。
结论
PDA 结扎后使用米力农与改善住院期间结局（如死亡率和发病率）无关。
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