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題 名 | Symptomatic Patent Ductus Arteriosus in Very Low Birth Weight Infants=極低體重兒之存開性動脈導管 |
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作 者 | 李建動; 黃碧桃; 陸振翮; 宋文舉; 陳淑貞; | 書刊名 | 中華醫學雜誌 |
卷 期 | 61:2 1998.02[民87.02] |
頁 次 | 頁93-98 |
分類號 | 417.6232 |
關鍵詞 | 存開性動脈導管; 早產兒; 極低體重兒; Premature infant; Very low birth weight infant; Patent ductus arteriosus; |
語 文 | 英文(English) |
中文摘要 | 背景:隨著新生兒學的進步,早產兒的存活率提高許多。存開性動脈導管的診斷率也大幅提升。為了研究存開性動脈導管在國人極低體重兒的發生率及其治療結果,本研究收集本院新生兒加護病房六年來的早產兒資料並加以統計分析。 方法:自1990年1月至1995年12月,共有181例極低體重之早產兒(出生體重<1500g,懷孕週數<37週)住進本院新生兒加護病房。其中37例被診斷為有症狀之存開性動脈導管。本文乃回顧其病歷記錄,並分析其臨床資料。 結果:出生體重屬≦1000g及1001~1500g的早產極低體重兒,其患有症狀之存開性動脈導管的發生率,分別為20.9%及21.4%。有症狀之存開性動脈導管的診斷時間,比無症狀之存開性動脈導管的診斷時間明顯提早許多(3.6 ± 2.9天 vs 9.6 ± 17.2天,P=0.044,95% CI=0.2,11.8)。經限水及使用利尿劑等治療,無症狀之存開性動脈導管嬰兒,比有症狀之嬰兒更有機會自然關閉(58.3% vs 10.8%,p < 0.001,95% CI=17.9%,77.1%。)。33例有症狀之存開性動脈導管嬰兒,接受indomethacin治療,其中32例治療有效,一例治療無效。在治療有效的32例中,有4例在4到10天後存開性動脈導管被發現再度開啟。這4例及治療無效的那一例均接受手術全部存活。4例有症狀之存開性動脈導管的嬰兒死亡。這4例均沒有接受手術,死亡原因為呼吸衰竭(2例)、敗血症(1例)、壞死性腸炎(1例)。 結論:對於無症狀之存開性動脈導管嬰兒而言,以限水和使用利尿劑治療已足夠。但是對於有症狀之存開性動脈導管嬰兒,由於不易自然關閉動脈導管,因此應以indomethacin治療關閉存開性動脈導管。雖然極低體重兒對於indomethacin的治療效果不如較大的早產兒,但是倘若病嬰不是屬於存開性動脈導管依賴型之先天性心臟病,或不具有其他indomethacin的禁忌症,均應嘗試以indomethacin治療關閉存開性動脈導管。 |
英文摘要 | Background: Premature neonatal survival rates have increased significantly. The diagnosis of patent ductus arteriosus(PDA) has also increased. In this paper, we present our experience of incidence, clinical features and outcome of the treatment of symptomatic PDA in very low birth weight infants. Methods: From January 1990 to December 1995, 181 premature infant with birth weight less than 1,500 were admitted to the Neonatal Intensive Care Unit(NICU) of Veterans General Hospital-Taipei. Thirty-seven were diagnosed to have symptomatic PDA. By reviewing hospital records, the clinical features and outcome of treatment of these infants were analyzed retrospectively. Results: The incidence of symptomatic PDA was 20.9% and 21.4% in infants with birth weight less than or equal to 1,000g, 1,001-1,500g, respectively. The mean age at diagnosis of infants with symptomatic PDA was significantly less than those without symptoms(3.6±2.9 day vs 9.6±17.2 days, p=0.044, 95% CI=0.2-11.8). With fluid restriction and diuretic therapy, asymptomatic patients had a higher spontaneous ductal closure rate than symptomatic patient(58.3% vs 10.8%, p<0.001, 95% CI=17.9-7.1%). Thirtytwo(97.0%) infants with symptomatic PDA responded to indomethacin therapy. However, four infants(12.1%) had recurrence. These four infant and a nonresponder received surgical ligation of the PDA and survived. There were four deaths. The reasons for death were respiratory failure in two, sepsis in one and necrotizing enterocolitis with intestinal perforation in one. Conclusions: Conservative medical management such as fluid restriction and diuretics are often adequate for asymptomatic PDA. However, since symptomatic PDA tends not to close spontaneously, patients should be treated with indomethacin if ductal shunting compromises cardiopulmonary function. |
本系統中英文摘要資訊取自各篇刊載內容。