有血流动力学意义的动脉导管未闭早产儿布洛芬治疗失败的危险因素分析

doi:10.7499/j.issn.1008-8830.2310145

摘要
图/表
参考文献(26)
相关文章 (15)
点击分布统计
下载分布统计

全文: PDF (588 KB) [HTML]
输出: BibTeX | EndNote (RIS) 背景资料

摘要目的研究有血流动力学意义的动脉导管未闭（hemodynamically?significant?patent?ductus?arteriosus, hsPDA）早产儿布洛芬治疗失败的高危因素。方法回顾性收集华中科技大学同济医学院附属湖北妇幼保健院新生儿科2018年1月—2023年6月收治的胎龄<34周hsPDA早产儿的临床资料，根据治疗方式的不同分为布洛芬组（95例）和布洛芬+手术组（44例），采用二元logistic回归分析探讨hsPDA早产儿布洛芬治疗失败的高危因素。结果二元logistic回归分析显示，动脉导管直径增大、大脑中动脉阻力指数（resistance index, RI）值≥0.80、总有创机械通气时间延长是hsPDA早产儿布洛芬治疗失败的高危因素（P<0.05）。受试者操作特征曲线分析显示，动脉导管直径>2.85 mm，大脑中动脉RI值≥0.80，总有创机械通气时间>16 d对hsPDA早产儿布洛芬治疗失败具有预测价值（P<0.05）；三者联合预测价值最高，曲线下面积为0.843，灵敏度为86.5%，特异度75.0%（P<0.05）。结论动脉导管直径>2.85 mm、大脑中动脉RI值≥0.80、总有创机械通气时间>16 d是hsPDA早产儿布洛芬治疗失败的高危因素，并对临床上布洛芬治疗失败需手术治疗具有重要参考意义。

	服务

	把本文推荐给朋友
	加入我的书架
	加入引用管理器
	E-mail Alert
	RSS
	作者相关文章
	吴梓琪
	张漪
	周茜茜
	刘沁
	程实
	夏世文

关键词 ：动脉导管未闭, 布洛芬治疗, 动脉导管未闭手术结扎, 高危因素, 早产儿

Abstract：Objective To investigate the risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus (hsPDA). Methods A retrospective collection of clinical data was conducted on preterm infants with a gestational age of <34 weeks who were diagnosed with hsPDA and treated at the Department of Neonatology, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, from January 2018 to June 2023. The subjects were divided into two groups based on the treatment approach: the ibuprofen group (95 cases) and the ibuprofen plus surgery group (44 cases). The risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA were identified by binary logistic regression analysis. Results The binary logistic regression analysis revealed that an increased diameter of the ductus arteriosus, a resistance index (RI) value of the middle cerebral artery ≥0.80, and prolonged total invasive mechanical ventilation time were risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). Receiver operating characteristic curve analysis showed that a ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days had significant predictive value for the failure of ibuprofen treatment in preterm infants with hsPDA (P<0.05). The combined predictive value of these three factors was the highest, with an area under the curve of 0.843, a sensitivity of 86.5%, and a specificity of 75.0% (P<0.05). Conclusions A ductus arteriosus diameter >2.85 mm, a middle cerebral artery RI value ≥0.80, and a total invasive mechanical ventilation time >16 days are risk factors for the failure of ibuprofen treatment in preterm infants with hsPDA, and they are of significant predictive value for the necessity of surgical treatment following the failure of ibuprofen treatment.

Key words： Patent ductus arteriosus Ibuprofen treatment Surgical ligation of the ductus arteriosus Risk factor Preterm infant

收稿日期: 2023-10-30

基金资助:中国疾控中心妇幼中心母婴营养与健康研究项目（2022FYH002）。

通讯作者: 夏世文，男，主任医师，教授。Email：shiwenxia66@163.com。 E-mail: shiwenxia66@163.com

作者简介: 吴梓琪，女，硕士研究生，住院医师；

引用本文:

吴梓琪,张漪,周茜茜等. 有血流动力学意义的动脉导管未闭早产儿布洛芬治疗失败的危险因素分析[J]. 中国当代儿科杂志, 2024, 26(4): 343-349.

WU Zi-Qi,ZHANG Yi,ZHOU Qian-Qian et al. Risk factors for the failure of ibuprofen treatment in preterm infants with hemodynamically significant patent ductus arteriosus[J]. CJCP, 2024, 26(4): 343-349.

链接本文:

http://www.zgddek.com/CN/10.7499/j.issn.1008-8830.2310145 或 http://www.zgddek.com/CN/Y2024/V26/I4/343

	Van Overmeire B, Smets K, Lecoutere D, et al. A comparison of ibuprofen and indomethacin for closure of patent ductus arteriosus[J]. N Engl J Med, 2000, 343(10): 674-681. PMID: 10974130. DOI: 10.1056/NEJM200009073431001.
	Mitra S, de Boode WP, Weisz DE, et al. Interventions for patent ductus arteriosus (PDA) in preterm infants: an overview of Cochrane systematic reviews[J]. Cochrane Database Syst Rev, 2023, 4(4): CD013588. PMID: 37039501. PMCID: PMC10091483. DOI: 10.1002/14651858.CD013588.pub2.
	Abu-Shaweesh JM, Almidani E. PDA: does it matter?[J]. Int J Pediatr Adolesc Med, 2020, 7(1): 9-12. PMID: 32373696. PMCID: PMC7193069. DOI: 10.1016/j.ijpam.2019.12.001.
	Hamrick SEG, Sallmon H, Rose AT, et al. Patent ductus arteriosus of the preterm infant[J]. Pediatrics, 2020, 146(5): e20201209. PMID: 33093140. PMCID: PMC7605084. DOI: 10.1542/peds.2020-1209.
	Lago P, Bettiol T, Salvadori S, et al. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus: a randomised controlled trial[J]. Eur J Pediatr, 2002, 161(4): 202-207. PMID: 12014386. DOI: 10.1007/s00431-002-0915-y.
	Ohlsson A, Walia R, Shah SS. Ibuprofen for the treatment of patent ductus arteriosus in preterm or low birth weight (or both) infants[J]. Cochrane Database Syst Rev, 2020, 2(2): CD003481. PMID: 32045960. PMCID: PMC7012639. DOI: 10.1002/14651858.CD003481.pub8.
	Lee JH, Lee HJ, Park HK, et al. Surgical ligation of patent ductus arteriosus in preterm neonates weighing less than 1500 g: a 9-year single center experience[J]. J Cardiothorac Surg, 2020, 15(1): 144. PMID: 32552772. PMCID: PMC7298442. DOI: 10.1186/s13019-020-01191-2.
	Malviya MN, Ohlsson A, Shah SS. Surgical versus medical treatment with cyclooxygenase inhibitors for symptomatic patent ductus arteriosus in preterm infants[J]. Cochrane Database Syst Rev, 2013, 2013(3): CD003951. PMID: 23543527. PMCID: PMC7027388. DOI: 10.1002/14651858.CD003951.pub3.
	9 姜静婧, 李正红, 张朕杰, 等. 有血流动力学意义的动脉导管未闭早产儿手术治疗危险因素巢式病例对照研究[J]. 中华实用儿科临床杂志, 2023, 38(3): 210-214. DOI: 10.3760/cma.j.cn101070-20220425-00449.
	Dutta S, Singh B, Chessell L, et al. Guidelines for feeding very low birth weight infants[J]. Nutrients, 2015, 7(1): 423-442. PMID: 25580815. PMCID: PMC4303848. DOI: 10.3390/nu7010423.
	Moore TA, Wilson ME. Feeding intolerance: a concept analysis[J]. Adv Neonatal Care, 2011, 11(3): 149-154. PMID: 21730906. DOI: 10.1097/ANC.0b013e31821ba28e.
	12 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 5版. 北京: 人民卫生出版社, 2019.
	Edstedt Bonamy AK, Gudmundsdottir A, Maier RF, et al. Patent ductus arteriosus treatment in very preterm infants: a European population-based cohort study (EPICE) on variation and outcomes[J]. Neonatology, 2017, 111(4): 367-375. PMID: 28125815. DOI: 10.1159/000454798.
	Tissot C, Singh Y. Neonatal functional echocardiography[J]. Curr Opin Pediatr, 2020, 32(2): 235-244. PMID: 32068595. DOI: 10.1097/MOP.0000000000000887.
	Clyman RI. Patent ductus arteriosus, its treatments, and the risks of pulmonary morbidity[J]. Semin Perinatol, 2018, 42(4): 235-242. PMID: 29958703. DOI: 10.1053/j.semperi.2018.05.006.
	Kluckow M, Evans N. Ductal shunting, high pulmonary blood flow, and pulmonary hemorrhage[J]. J Pediatr, 2000, 137(1): 68-72. PMID: 10891824. DOI: 10.1067/mpd.2000.106569.
	刘太祥, 马晓路, 陈正, 等. 极低出生体重儿动脉导管未闭手术结扎时机的研究[J]. 中国当代儿科杂志, 2022, 24(5): 500-506. PMID: 35644189. PMCID: PMC9154378. DOI: 10.7499/j.issn.1008-8830.2112151.
	Toyoshima K, Isayama T, Kobayashi T, et al. What echocardiographic indices are predictive of patent ductus arteriosus surgical closure in early preterm infants? A prospective multicenter cohort study[J]. J Cardiol, 2019, 74(6): 512-518. PMID: 31256929. DOI: 10.1016/j.jjcc.2019.05.004.
	Masutani S, Isayama T, Kobayashi T, et al. Ductus diameter and left pulmonary artery end-diastolic velocity at 3 days of age predict the future need for surgical closure of patent ductus arteriosus in preterm infants: a post-hoc analysis of a prospective multicenter study[J]. J Cardiol, 2021, 78(6): 487-492. PMID: 34481720. DOI: 10.1016/j.jjcc.2021.08.007.
	Kwinta P, Rudziński A, Kruczek P, et al. Can early echocardiographic findings predict patent ductus arteriosus?[J]. Neonatology, 2009, 95(2): 141-148. PMID: 18776728. DOI: 10.1159/000153098.
	21 孙红光, 於晓平, 戚庭月. 早产儿大脑中动脉血流参数与脑损伤关系的探讨[J]. 医学影像学杂志, 2009, 19(8): 950-952. DOI: 10.3969/j.issn.1006-9011.2009.08.005.
	Ecury-Goossen GM, Raets MM, Camfferman FA, et al. Resistive indices of cerebral arteries in very preterm infants: values throughout stay in the neonatal intensive care unit and impact of patent ductus arteriosus[J]. Pediatr Radiol, 2016, 46(9): 1291-1300. PMID: 27259991. PMCID: PMC4943974. DOI: 10.1007/s00247-016-3615-x.
	Weir FJ, Ohlsson A, Myhr TL, et al. A patent ductus arteriosus is associated with reduced middle cerebral artery blood flow velocity[J]. Eur J Pediatr, 1999, 158(6): 484-487. PMID: 10378397. DOI: 10.1007/s004310051125.
	Camfferman FA, de Goederen R, Govaert P, et al. Diagnostic and predictive value of Doppler ultrasound for evaluation of the brain circulation in preterm infants: a systematic review[J]. Pediatr Res, 2020, 87(Suppl 1): 50-58. PMID: 32218536. PMCID: PMC7098887. DOI: 10.1038/s41390-020-0777-x.
	Mashally S, Nield LE, McNamara PJ, et al. Late oral acetaminophen versus immediate surgical ligation in preterm infants with persistent large patent ductus arteriosus[J]. J Thorac Cardiovasc Surg, 2018, 156(5): 1937-1944. PMID: 30007780. DOI: 10.1016/j.jtcvs.2018.05.098.
	Willis KA, Weems MF. Hemodynamically significant patent ductus arteriosus and the development of bronchopulmonary dysplasia[J]. Congenit Heart Dis, 2019, 14(1): 27-32. PMID: 30343505. DOI: 10.1111/chd.12691.