A Survey on the Treatment Strategy of Patent Ductus Arteriosus in Very Low-Birth-Weight Infants

極低體重兒存開性動脈導管治療方法之調查

蘇百弘(Bai-Horng Su) ； 胡博翔(Paul-Shiang Hu) ； 黃鴻偉(Hung-Wei Huang) ； 劉凌玉(Lin-Yu Liu) ； 楊鵬弘(Peng-Hong Yang) ； 葉秀珍(Marguerite Billiet)

《Acta Paediatrica Sinica》 39卷1期 (1998/02) Pp. 33-37

https://doi.org/10.7097/APS.199802.0033

摘要

本研究目的爲回溯性檢討極低體重兒存開性動脈導管(PDA)之治療。研究對象爲自1996年1月1日到1996年12月31日止在四家醫院的新生兒加護病房住院的出生體重小於1500公克患有症候性PDA之早産兒。共收集了67名個案爲研究之材料。結果顯示56個嬰兒(83.6%)有呼吸窘迫症候群(RDS)，其中有53名(79%)接受Survanta補充治療。平均懷孕週數27.9±2.4週，平均出生體重1078±293公克。用來做爲使用Indomethacin治療PDA的基准爲：有一家醫院以CVD≧3爲唯一的基准，另外三家醫院主要是以彩色Doppler心臓超音波檢查做爲治療的基准，有時會以LA/AO≧1.3爲治療的基准。其中有2家醫院有時也會使用Pulsed Doppler心臓超音波檢查做爲治療的基准。有7名嬰兒(10.5%)合併有Indomethacin的使用禁忌，其中3名接受外科結雜術，4名接受保守性內科療法而使PDA關閉。另外60名嬰兒，除了3名接受口服Indomethacin治療以外，都是接受靜注Indomethacin治療。初回治療日齡平均爲3.8±1.5天，其中10名(16.7%)24小時內，25名(41.7%)在24~48小時內，25名(41.7%)超過生後48小時。Indomethacin的劑量爲每回0.2mg/kg，如果沒有投予禁忌，第隔12~24小時投予以3回爲一個course。平均接受Indomethacin劑數爲2.8±1.5，PDA關閉率爲85%(51/60)。有25名嬰兒(41.7%)只接受1劑或2劑，其PDA關閉率爲84%(21/25)。有32~52%的嬰兒發生Indomethacin治療後的併發症，大都發生在生後48小時內接受首劑Indomethacin的嬰兒。合併有RDS的早産兒其首劑治療日齡比沒有合併RDS的早産兒爲早(3.3±2.5天 VS.57%；P＜0.05)。結論是在極低體重兒使用Indomethacin可以使症候性PDA關閉。即使只接受1劑或2劑的嬰兒也有PDA關閉的機會。爲了減少在極低體重兒使用Indomethacin發生併發症的機率，對現行使用Indomethacin的方法有再加評估的必要。

關鍵字

極低體重兒 ； 存開性動脈導管 ； Indomethacin

並列摘要

This study is a retrospective analysis of the clinical data of 67 very low birth weight infants (VLBWI) with symptomatic patent ductus arteriosus (PDA), all were admitted to four neonatal intensive care units (NICU) from January 1, 1996 through December 31, 1996. The mean gestational age was 27.9±2.4 weeks, the mean birth weight was 1078±293g. Fifty-six infants (83.6%) had RDS, and 53 infants (79%) received artificial surfactant. The NICU at a regional hospital used CVD score ≧3 as the sole criteria and the remaining three NICUs used color Doppler echocardiogram to confirm a symptomatic FDA and to treat it; sometimes LA/AO ≧1.3 was used as the criteria for indomethacin treatment. Two of these three hospitals sometimes used the pulsed Doppler echocardiogram as well as color Doppler examination as the treatment criteria. Seven infants (10.5%) had contraindication for indomethacin treatment; four of them closed after conservative treatment, and another three were subjected to surgical ligation. Of the remaining 60 infants, 3 were treated with oral indomethacin and 57 were treated with intravenous indomethacin. The mean age when, initial treatment given was 3.8th 1.5 days (range, 8 hours-20 days). Among them 10 (16.7%) were within 24 hours after birth, 25 (41.7%) were between 24 and 48 hours, and 25 (41.7%) were beyond 48 hours. The dosage of indomethacin was 0.2mg/kg per dose intravenously every 12 to 24 hours for three doses as a full course, if not contraindicated. The mean dose of indomethacin was 2.8±1.5; 10 infants (16. 7%) received I dose, 15 (25%) received 2 doses, 27 (45%) received 3 doses, 3 (5%) received 4 doses and 5 (8.3%) received 6 doses. Among them, 51 infants (85%) PDA closed(including 2 treated with oral indomethacin), 9 (15%) failed to close and 6 of them received surgical ligation (including I treated with oral indomethacin). The complications associated with indomethacin treatment were hypoglycemia (52%), decreased urine output (42%) and gastrointestinal hemorrhage (32%). The infants with RDS had an earlier mean age of initial treatment than non-RDS infants (3.3±2.5 vs. 7.6±5.6 days; p＜0.05), and also had a higher closure rate (89% vs. 57%; p＜0.05). There was a closure rate of 85% in this multicenter retrospective analysis. Even though the infants received only one or two doses, they still had a good chance of ductal closure (21/25, 84%). To minimize the complications associated with indomethacin treatment in VLB WI, the protocol of indomethacin treatment should be re-evaluated.

並列關鍵字

very low-birth-weight infants ； patent ductus arteriosus ； indomethacin