摘要
目的 探讨早产儿动脉导管未闭(PDA)的危险因素及血流动力学变化.方法 111例早产儿根据有无PDA分为PDA组37例及无PDA(nPDA)组74例.再根据有无新生儿呼吸窘迫综合征(NRDS)分为四组:有 NRDS-有 PDA(NRDS-PDA)组 25 例、有 NRDS-无 PDA(NRDS-nPDA)组20 例、无NRDS-有PDA(nNRDS-PDA)组 12 例、无 NRDS-无 PDA(nNRDS-nPDA)组 54 例.收集临床资料和血流动力学参数,分析早产儿发生PDA的危险因素及其对血流动力学的影响.结果 胎龄、出生体重、1-min Apgar评分、5-min Apgar评分、10-min Apgar评分、NRDS、有创呼吸支持与早产儿PDA有关(P＜0.05).NRDS是早产儿发生PDA的独立危险因素(P＜0.05).NRDS-PDA组每搏输出量(SV)、每搏输出量指数(SI)、心输出量(CO)、心指数(CI)均高于NRDS-nPDA组,总外周阻力指数(TPRI)低于 NRDS-nPDA 组(P＜0.05).nNRDS-PDA 组 SI、CO、CI 均高于 nNRDS-nPDA组,TPRI低于nNRDS-nPDA组(P＜0.05).SV、SI、CO、CI较高和TPRI较低是NRDS早产儿发生PDA的独立危险因素(P＜0.05),SI、CO、CI较高和TPRI较低是无NRDS早产儿发生PDA的独立危险因素(P＜0.05).结论 NRDS是早产儿发生PDA的独立危险因素.对于NRDS早产儿,SV、SI、CO、CI较高和TPRI较低是其发生PDA的独立危险因素.对于无NRDS早产儿,SI、CO、CI较高和TPRI较低是其发生PDA的独立危险因素.
Abstract
Objective To study the risk factors and hemodynamic changes caused by patent ductus arteriosus(PDA)in preterm infants.Methods A total of 111 preterm infants were divided into PDA group(with PDA,37 cases)and nPDA group(without PDA,74 cases).The preterm infants were then divided into NRDS-PDA group(with NRDS and PDA,25 cases),NRDS-nPDA group(with NRDS and without PDA,20 cases),nNRDS-PDA group(without NRDS and with PDA,12 cases),and nNRDS-nPDA group(without NRDS and PDA,54 cases).The clinical data and hemodynamic parameters were collected.The risk factors of PDA were analyzed and its impact on hemodynamics in preterm infants.Results The gestational age,birth weight,1-min Apgar score,5-min Apgar score,10-min Apgar score,NRDS and invasive respiratory support were associated with PDA(P＜0.05).NRDS was an independent risk factor for PDA in preterm infants(P＜0.05).The stroke volume(SV),stroke volume index(SI),cardiac output(CO)and cardiac index(CI)were higher,and total peripheral resistance index(TPRI)was lower in NRDS-PDA group than those in NRDS-nPDA group(P＜0.05).The SI,CO and CI were higher and TPRI was lower in nNRDS-PDA group than those in nNRDS-nPDA group(P＜0.05).Higher SV,SI,CO and CI and lower TPRI were the independent risk factors for PDA in preterm infants with NRDS(P＜0.05).Higher SI,CO and CI and lower TPRI were the independent risk factors for PDA in preterm infants without NRDS(P＜0.05).Conclusion NRDS is an independent risk factor for PDA in preterm infants.Higher SV,SI,CO and CI and lower TPRI are the independent risk factors for PDA in preterm infants with NRDS.Higher SI,CO and CI and lower TPRI are the independent risk factors for PDA in preterm infants without NRDS.
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