目的 回顾性分析112例动脉导管未闭(PDA)早产儿的临床特征及血压、左心室输出量(CO)、左心室缩短分数(LVFS)及左心室射血分数(LVEF)等相关心脏血流动力学的变化.方法 选择2014年10月至2016年9月生后24 h内入住新生儿重症监护室(NICU)的112例早产儿为研究对象.出生后第2天、第5天行床旁超声心动图(UCG)检查,并根据第2天的结果将入组患儿分为PDA组49例,非动脉导管未闭(nPDA)组63例.观察2组患儿一般情况、动脉导管内径、心脏血流动力学指标和合并症的发生情况.PDA组出生24 h后开始服用布洛芬,每剂间隔24 h,连服3剂.用χ2检验分析2组性别差异和机械通气的使用情况,而2组间出生体重、胎龄、平均住院日和心率、舒张压、收缩压、脉压、CO、LVFS、LVEF等心脏血流动力学指标的比较用独立样本t检验,用配对t检验分析比较PDA组用药前后动脉导管的内径变化.结果 PDA组胎龄、出生体重明显小于nPDA组(P=0.003、0.017);PDA组机械通气使用率明显高于nPDA组(χ2=11.05,P=0.001),PDA组平均住院日也显著高于nPDA组[(40 ± 22)d、(30 ± 12)d,P=0.003].出生后第2天PDA组心率、脉压和心输出量(CO)明显高于nPDA组(P=0.001、0.003、0.010),舒张压明显低于后者(P=0.000),而2组收缩压、LVFS和LVEF之间差异无统计学意义(P均>0.05).PDA组严重感染(肺炎、败血症等)、新生儿呼吸窘迫综合征(NRDS)和支气管肺发育不良(BPD)等合并症的发生率明显高于nPDA组(P=0.010、0.009、0.015),而2组血小板减少发生率差异无统计学意义(P=0.135).服用布洛芬3个疗程及出生后第5天,PDA组动脉导管平均内径较用药前明显减小[(3.0 ± 0.7)mm、(1.4 ± 1.2)mm,P=0.000],PDA组心率、脉压和CO与nPDA组差异无统计学意义(P均>0.05),而PDA组舒张压仍高于nPDA组(P=0.000).结论 PDA早产儿具有临床特征多样、心脏血流动力学复杂等特点,且合并症发生率较高.而早期服用布洛芬能促进动脉导管闭合,改善血流动力学.%Objective To analyze retrospectively the changes of clinical characteristics and related cardiac hemodynamic indexes including blood pressure,left ventricular output (CO),left ventricular shortening fraction (LVFS),left ventricular ejection fraction (LVEF) in 112 premature infants with patent ductus ateriosus (PDA).Methods One hundred and twelve premature infants with PDA who were treated in NICU of our hospital within 24h after birth from October 2014 to September 2016 were enrolled in the study. These neonates were examined by echocardiography to detect hemodynamic changes and ductus arteriosus (DA) diameter on 2d,5d after birth.According to echocardiographic examination results on 2d after birth,the neonates were divided into 2 groups:PDA group(n=49) and nPDA group(n=63).The general conditions, DA diameter,cardiac hemodynamic indexes and complications were observed and compared between two groups. The patients in PDA group were given ibuprofen on 24h after birth,at an interval of 24h,for three treatment courses.The sex differences, mechanical ventilation usage,mean gestational age (GA), birth weight (BW),average length of staying in hospital,heart rate, diastolic blood pressure,systolic blood pressure,pulse pressure,CO,LVFS,LVEF were statistically analyzed and compared between two groups. Results The GA and BW in PDA group were significantly lower than those in nPDA group (P<0.01,P<0.05),however,the mechanical ventilation use rate in PDA group was significantly higher than that in nPDA group(χ2=11.05,P<0.01),moreover,the average length of staying in hospital in PDA group was significantly higher than that in nPDA group [(40 ± 22)d vs(30 ± 12)d,P<0.01].The heart rate,pulse pressure and CO on 2d after birth in PDA group were significantly higher than those in nPDA group (P<0.01 or P<0.05),but diastolic blood pressure in PDA group was significantly lower than that in nPDA group (P<0.01).However there were no significant differences in systolic blood pressure,LVFS and LVEF between the two groups (P >0. 05). The incidence rates of complications including serious infections (pneumonia,sepsis,etc.),NRDS,BPD in PDA group were significantly higher than those in nPDA group(P<0.01 or P<0.05),however,there were no significant differences in incidence rates of thrombocytopenia between two groups(P>0.05). The mean DA diameter in PDA group after three treatment courses with ibuprofen and on 5d after birth was significantly decreased [(3.0 ± 0.7)mm,(1.4 ± 1.2)mm,P<0.01],but there were no significant differences in heart rate, pulse pressure and CO between two groups(P>0.05),moreover,the diastolic blood pressure in PDA group was significantly higher than that in nPDA group (P < 0. 01). Conclusion The premature infants with PDA have multiple clinical characteristics and complex cardiac haemodynamics,and have higher incidence rates of complications.Moreover oral ibuprofen early can promote the closure of ductus and improve the hemodynamics of heart.
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