采用保守方法治疗血流动力学意义重大的 PDA 后疗效更佳:两个时期的比较。

IF 1.9 4区 医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Cardiology Pub Date : 2024-09-24 DOI:10.1159/000541477
Yu-Mi Seo, Sae Yun Kim, Young-Ah Youn
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引用次数: 0

摘要

导言:动脉导管未闭(PDA)是一种常见病,发病率与胎龄成反比。为了顺应避免结扎 PDA 和预防性干预的趋势,本中心从 2020 年 9 月开始采用保守方法。本研究旨在评估在采取保守治疗方法期间,对有血流动力学显著性(hs)的 PDA 采取保守治疗方法是否减少了极低出生体重儿(VLBWI)的不良临床结局:由于自 2020 年 9 月起对有血流动力学意义(hs)的 PDA 采用了更为保守的方法,因此将两个时期分为第一时期(2015 年 1 月至 2020 年 8 月)和第二时期(2020 年 9 月至 2023 年 6 月)。从第 1 天起,对所有 VLBWI 进行仔细监测并推进液体疗法,而在第 2 阶段,对 hs PDA 尝试了更为保守的液体限制方法:结果:在 540 名患有 hs PDA 的 VLBWI 中,有 348 名婴儿出生后被诊断为患有 hs PDA。第二阶段的医疗治疗率明显较高(79.17% 对 19.51%),PDA 结扎率较低(54.17% 对 78.05%)。与第一阶段相比,第二阶段更坚持保守的液体限制。第二阶段的 BPD 和 BPD ≥ 中度、败血症、NEC(≥ 2 级)、IVH(≥ 3 级)明显较低,死亡率也较低。在与 PDA 相关的治疗方面,第 1 期的初次 PDA 结扎率明显较高,而第 2 期的医疗失败后二次 PDA 结扎率和更保守的液体限制率明显较高。在 18-24 个月校正年龄时,第一阶段出生的 VLBWI 的认知评分明显低于第二阶段出生的 VLBWI:我们的研究表明,与主动结扎 PDA 的时期相比,对 hs PDA 采取保守治疗可获得更好的临床效果,并在 18-24 个月大时提高认知评分。这种保守策略包括更精确的液体限制和合理使用适当的利尿剂,已证明能以最少的干预改善临床效果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Improved Outcomes following a Conservative Approach to Hemodynamically Significant Patent Ductus Arteriosus: A Comparison across Two Periods.

Introduction: Patent ductus arteriosus (PDA) is a commonly encountered morbidity that occurs inversely with gestational age. In response to the growing trend of avoiding PDA ligation and prophylactic interventions, our center adopted a conservative approach starting in September 2020. This approach involves more precise fluid restriction for hemodynamically significant (hs) PDA. This study aimed to evaluate whether a conservative approach to hsPDA has led to a reduction in adverse clinical outcomes for very low birth weight infants (VLBWIs) during the period of conservative treatment.

Methods: Since more conservative approach to hsPDA was adopted since September 2020, the two periods were divided into period 1 (January 2015 to August 2020) and period 2 (September 2020 to June 2023). Fluid therapy was carefully monitored and advanced from day 1 in all VLBWI, and a more conservative approach as fluid restriction was attempted in hsPDA during period 2.

Results: Of the 540 VLBWI with hsPDA, 348 infants were born and diagnosed with hsPDA. Period 2 demonstrated a significantly higher rate of medical treatment (79.17% vs. 19.51%) and lower PDA ligation (54.17% vs. 78.05%). Period 2 showed a greater adherence to conservative fluid restriction compared to period 1. Bronchopulmonary dysplasia (BPD) and BPD ≥ moderate, sepsis, necrotizing enterocolitis (≥ grade 2), IVH (grade ≥3) were notably lower in period 2 with lower mortality. In regard to PDA-related treatment, primary PDA ligation was significantly higher in period 1. The secondary PDA ligation after medical failure and more conservative fluid restriction were significantly higher in period 2. At corrected age of 18-24 months, cognitive score was significantly lower in VLBWI born in period 1 compared to those born in period 2.

Conclusion: Our study demonstrated that a conservative approach to hsPDA led to better clinical outcomes and improved cognitive scores at a corrected age of 18-24 months compared to the period of active PDA ligation. This conservative strategy, involving more precise fluid restriction and the judicious use of appropriate diuretics, has shown to improve clinical outcomes with minimal intervention.

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来源期刊
Cardiology
Cardiology 医学-心血管系统
CiteScore
3.40
自引率
5.30%
发文量
56
审稿时长
1.5 months
期刊介绍: ''Cardiology'' features first reports on original clinical, preclinical and fundamental research as well as ''Novel Insights from Clinical Experience'' and topical comprehensive reviews in selected areas of cardiovascular disease. ''Editorial Comments'' provide a critical but positive evaluation of a recent article. Papers not only describe but offer critical appraisals of new developments in non-invasive and invasive diagnostic methods and in pharmacologic, nutritional and mechanical/surgical therapies. Readers are thus kept informed of current strategies in the prevention, recognition and treatment of heart disease. Special sections in a variety of subspecialty areas reinforce the journal''s value as a complete record of recent progress for all cardiologists, internists, cardiac surgeons, clinical physiologists, pharmacologists and professionals in other areas of medicine interested in current activity in cardiovascular diseases.
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