背景:目前尚不清楚全身至肺动脉分流术中动脉导管未闭的最佳管理方法。这项研究的目的是检查Blalock-Taussig-Thomas分流手术期间动脉导管未闭管理的可变策略的结果。
方法:对接受分流术的婴儿进行了回顾性队列研究,将结扎导管的人与保留导管的人进行比较。低心输出量综合征的指标,坏死性小肠结肠炎的发展,并检查了次要结局,如复苏事件.
结果:36例婴儿均通过正中胸骨切开术进行分流术。20名婴儿在分流时结扎了导管,他们与16名导管开放的婴儿进行了比较。术前基线特征无统计学差异,包括矫正胎龄,以天为单位的年龄,体重,机械通气,血管活性的使用,异质,和肠胃异常.术后低心输出量指标也无统计学差异,包括尿液生产,给定的总流体,肾损伤,最大乳酸,和血管活性-正性肌力评分。3例患者术后肾损伤,都在结扎管组。任何次要结局也没有统计学差异,包括坏死性子宫内膜炎的发展,复苏事件,再干预,插管长度,总停留时间,和死亡率。
结论:本研究提供了证据,证明分流术期间导管的可变管理不会显著影响结局。保持导管开放可以提供潜在的肺血流救援来源,并且似乎不会增加术后低心输出量的风险。
BACKGROUND: The optimal approach to patent ductus arteriosus management during systemic-to-pulmonary artery shunt placement is currently unknown. The purpose of this study is to examine the outcomes of variable strategies for patent ductus arteriosus management during Blalock-Taussig-Thomas shunt surgery.
METHODS: A retrospective cohort study of infants who underwent shunt placement was performed, comparing those who had the ductus ligated with those who had the ductus left open. Indicators of low cardiac output syndrome, development of necrotizing enterocolitis, and secondary outcomes such as resuscitation events were examined.
RESULTS: Thirty-six infants were included all of whom had their shunt placed via median sternotomy. Twenty infants had their ductus ligated at the time of the shunt, and they were compared with 16 infants whose ductus was left open. There was no statistical difference in preoperative baseline characteristics, including corrected gestational age, age in days, weight, mechanical ventilation, vasoactive use, heterotaxy, and gastrointestinal anomalies. There was also no statistical difference in postoperative indicators of low cardiac output, including urine production, total fluids given, renal injury, maximum lactate, and vasoactive-inotropic score. Three patients had postoperative renal injury, and all were in the ligated duct group. There was also no statistical difference in any secondary outcomes, including the development of necrotizing eneterocolitis, resuscitation events, reinterventions, length of intubation, total length of stay, and mortality.
CONCLUSIONS: This study provides evidence that variable management of the ductus during shunt placement does not significantly impact outcomes. Leaving the ductus open allows for a potential rescue source of pulmonary blood flow and does not appear to increase the risk of postoperative low cardiac output.