Surgical Ligation of Patent Ductus Arteriosus in Extremely Low Birth Weight Premature Neonates

背景　對於早產兒的開放性動脈導管可以經由積極的抗鬱血性療法，給予indomethacin，或是外科手術來關閉。長久以來，雖然可能造成腎功能不良、壞死性腸炎，以及腦室內出血等併發症，indomethacin一直是早產兒開放性動脈導管治療的首選藥物。歷年文獻關於indomethacin的使用成效，報告有所差異，因此部分學者提出了早期手術關閉的主張。方法　針對本院1999年1月至2002年1月間57位存有開放性動脈導管的極度低體重早產兒（出生體重1000公克以下）進行回溯性的研究。其中16位僅接受積極的抗鬱血性療法，另外27位分別給予1到2個indomethacin療程，有22位病人因為對indomethacin有使用禁忌或indomethacin治療失敗，接受了外科關閉手術。結果　對於indomethacin治療的反應率為70.4%，沒有與手術本身相關的死亡個案。與indomethacin使用相關的不良障害發生率與文獻報告接近。相較於indomethacin使用組，手術接受組之腎功能不良比例較高，因為這些病人就是由於腎功能不良才無法給予indomethacin而接受手術關閉。在治療後的插管天數、住院日數、及出院時仍需要氣氣的比例方面，indomethacin使用組與手術接受組並沒有統計學上的差異。結論　對於處理極度低體重早產兒的開放性動脈導管，若事先考慮到indomethacin治療可能無效或是可能導致嚴重不良障害者，早期外科關閉手術不失為另一個良好的選擇。

關鍵字

動脈導管關閉手術；極度低體重早產兒； indomethacin併發症

並列摘要

Background: Closure of a patent ductus arteriosus (PDA) in premature neonates may be achieved through vigorous medical management alone, indomethacin administration, or surgical ligation. Indomethacin has been the initial treatment of choice for PDA in premature neonates despite reports of varying success and the risk of renal insufficiency, necrotizing enterocolitis, and intraventricular hemorrhage. Early surgical therapy has been advocated with variable results. Methods: From January of 1999 to January of 2002, the charts of 57 extremely low birth weight (weighing less than 1000g) neonates who had a PDA were retrospectively reviewed in this series. Of them, 16 were only treated with aggressive medical therapy and 27 received one to two courses of intravenous indomethacin. Surgical ligation was performed in 22 patients in whom indomethacin therapy was contraindicated or failed. Results: The overall response rate to indomethacin alone was 70.4 per cent. No mortality was associated with the surgical procedure itself. The incidence of indomethacin-associated morbidity was comparable with that previously reported. The surgical group had higher rate of renal dysfunction than the indomethacin group because many patients in whom indomethacin was contraindicated due to renal problems received surgery. There was no difference in the post-treatment duration intubation, hospital stay, and rate of discharge on oxygen between the two groups. Conclusion: Surgical ligation of PDA might be considered early in the treatment of extremely low birth weight neonates who have either a lower probability of PDA closure with indomethacin or an increased risk of developing complications from this treatment.

並列關鍵字

PDA ligation ； Extremely low birth weight ； Indomethacin complications

國際替代計量

Surgical Ligation of Patent Ductus Arteriosus in Extremely Low Birth Weight Premature Neonates

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