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[早产儿血流动力学显著的动脉导管未闭结扎术后心肺功能障碍的危险因素]

[Risk factors for cardiopulmonary dysfunction after ligation of hemodynamically significant patent ductus arteriosus in preterm infants].

作者信息

Liu Chong-Chong, Liu Yong, Zhang Yi, Han Dai-Cheng, He Rui-Jing, Xia Shi-Wen

机构信息

Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, China com.

出版信息

Zhongguo Dang Dai Er Ke Za Zhi. 2025 Apr 15;27(4):425-431. doi: 10.7499/j.issn.1008-8830.2411050.

Abstract

OBJECTIVES

To investigate the risk factors for the occurrence of cardiopulmonary dysfunction following ligation of hemodynamically significant patent ductus arteriosus (hsPDA) in preterm infants.

METHODS

A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were admitted to the Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology from January 2018 to August 2024. These infants underwent hsPDA ligation after 1-2 courses of failed ibuprofen treatment. Based on the occurrence of blood pressure changes and oxygenation or ventilation failure postoperatively, the infants were divided into a cardiopulmonary dysfunction group (19 cases) and a non-cardiopulmonary dysfunction group (40 cases). Binary logistic regression analysis was performed to explore risk factors for postoperative cardiopulmonary dysfunction.

RESULTS

Binary logistic regression analysis indicated that a faster average weight gain rate preoperatively and low levels of free triiodothyronine (FT) within one week before surgery were risk factors for cardiopulmonary dysfunction following hsPDA ligation (<0.05). Receiver operating characteristic curve analysis showed that an average weight gain rate >11.45 g/(kg·d) and FT levels <2.785 pmol/L within one week before surgery had predictive value for postoperative cardiopulmonary dysfunction (<0.05). The combination of these two indicators provided the highest predictive value (<0.05), with an area under the curve of 0.825, a sensitivity of 79%, and a specificity of 75%.

CONCLUSIONS

An average weight gain rate exceeding 11.45 g/(kg·d) and FT levels below 2.785 pmol/L within one week before surgery are risk factors affecting cardiopulmonary function after hsPDA ligation. Preoperative assessment and intervention should be strengthened to reduce the risk of postoperative complications.

摘要

目的

探讨早产儿血流动力学显著的动脉导管未闭(hsPDA)结扎术后发生心肺功能障碍的危险因素。

方法

回顾性收集2018年1月至2024年8月在华中科技大学同济医学院附属湖北省妇幼保健院住院的孕周<34周的早产儿的临床资料。这些婴儿在布洛芬治疗1 - 2个疗程失败后接受hsPDA结扎术。根据术后血压变化及氧合或通气衰竭的发生情况,将婴儿分为心肺功能障碍组(19例)和非心肺功能障碍组(40例)。采用二元logistic回归分析探讨术后心肺功能障碍的危险因素。

结果

二元logistic回归分析表明,术前平均体重增加速度较快以及术前1周内游离三碘甲状腺原氨酸(FT)水平较低是hsPDA结扎术后发生心肺功能障碍的危险因素(P<0.05)。受试者工作特征曲线分析显示,术前平均体重增加速度>11.45 g/(kg·d)以及术前1周内FT水平<2.785 pmol/L对术后心肺功能障碍具有预测价值(P<0.05)。这两个指标联合使用时预测价值最高(P<0.05),曲线下面积为0.825,灵敏度为79%,特异度为75%。

结论

术前1周内平均体重增加速度超过11.45 g/(kg·d)以及FT水平低于2.785 pmol/L是影响hsPDA结扎术后心肺功能的危险因素。应加强术前评估和干预,以降低术后并发症的风险。

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本文引用的文献

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Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane Systematic Reviews.
Cochrane Database Syst Rev. 2023 Apr 11;4(4):CD013588. doi: 10.1002/14651858.CD013588.pub2.
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Neonatal Intensive Care Unit-Level Patent Ductus Arteriosus Treatment Rates and Outcomes in Infants Born Extremely Preterm.
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