刘启龙++++++文平++++++卢绪宁++++++朱全伟

[摘要] 目的 探讨早产儿动脉导管未闭（PDA）外科手术治疗的临床经验。 方法 回顾性分析2011年8月～2013年8月本院接受外科手术治疗的早产PDA患儿共19例，所有病例心前区均可闻及收缩期杂音，术前超声动脉导管直径3~6 mm，平均（3.6±0.5） mm。其中口服布洛芬关闭2次均失败7例，术前行机械通气治疗8例。对其术中、术后情况进行总结分析。 结果 手术时间为35~55 min，平均（48.0±15.3） min，术中均未输血。术后均行机械通气，时间为1~10 d，平均（3.5±2.3） d，撤机后均于3 d内离氧。术后行心脏超声检查均未见残余分流。术后7~20 d出院，平均（11.0±3.0） d。所有患儿术中、术后均无大出血。全组患儿无死亡，均痊愈出院。 结论 对早产儿PDA引发临床症状者及内科保守治疗无好转者，早期外科手术治疗是安全有效的治疗方法。

[关键词] 动脉导管未闭；婴儿；早产；手术治疗

[中图分类号] R722.6[文献标识码] B[文章编号] 1674-4721（2014）06（b）-0166-04

Surgical operation treatment of patent ductus arteriosus in preterm infants

LIU Qi-long WEN Ping LU Xu-ning ZHU Quan-wei

Department of Cardiothoracic Surgery,Dalian Children′s Hospital,Dalian 116012,China

[Abstract] Objective To discuss the clinical experience of surgical operation in treatment of patent ductus arteriosus (PDA) in preterm infants. Methods 19 cases of preterm infants with PDA in the hospital from August 2011 to August 2013 were reviewed and analyzed,and were accepted surgical operation treatment.Systolic murmur could be heard in precordium,diameter of arterial duct by preoperative ultrasound was 3 to 6 mm,averaging of (3.6±0.5) mm.Among the infants,2 cases were oral administration ibuprofen closure unsuccessful,8 cases were mechanical ventilation treatment before operation.The preterm infants condition of the intraoperative and postoperative was summarized. Results The time of operation was 35 to 55 min,average of (48.0±15.3) min,during the operation there was no transfusion.Postoperation,mechanical ventilation treatment was adopted about 1 to 10 days,average of (3.5±2.3) days.All infants left oxygen after weaning in 3 days.After operation the detection of ultrasound showed no residual shunt.Infants left hospital after 7 to 20 days treatment,average of (11.0±3.0) days.All of infants were cured,there was no massive hemorrhage and no death occurred during and after the operation. Conclusion For the preterm infants of PDA induced clinical symptoms and treated by conservative medicine unsuccessfully,the early surgical operation treatment of PDA in premature infants is safe and effective.

[Key words] Patent ductus arteriosus;Infants;Premature;Operation treatment

动脉导管未闭（patent ductus arteriosus，PDA）是早产儿最常见的先天性心脏异常。若不能及时诊断和治疗，常可诱发或促进充血性心力衰竭、呼吸窘迫综合征（respiratory distress syndrome，RDS）、慢性肺部疾病、颅内出血、坏死性小肠结肠炎（necrotizing enterocolitis，NEC）等疾病的发生发展，导致住院时间延长，是影响早产儿存活率和后遗症发生率的主要原因之一[1-2]。内科保守治疗PDA对低出生体重早产儿效果差，且存在诸多禁忌。近年来，随着早产儿麻醉、围术期管理的进步，生后早期手术治疗早产儿PDA的优势逐渐得到人们的认可。本文探讨早产儿PDA外科手术治疗的临床经验。

1 资料与方法

1.1 一般资料

选择2011年8月～2013年8月在本院心胸外科接受手术治疗的全部PDA早产儿。……