Medikal Tedaviye Yanıtsız Duktus Arteriosuslu Preterm İnfantların Tedavisinde Güvenli Bir Yöntem: Yatakbaşı Cerrahi ligasyon

Yıl 2019, Cilt: 9 Sayı: 2, 135 - 139, 30.06.2019

Davut Bozkaya Atakan Atalay Sabriye Korkut Cüneyt Tayman İrfan Taşoğlu

https://doi.org/10.16899/jcm.568276

Öz

The
appropriate management of patent ductus arteriosus (PDA) and associated
complications (such as congestive heart failure, bronchopulmonary dysplasia,
necrotizing enterocolitis, intracranial hemorrhage and death), which is one of
these morbidities, is very important for the improvement of short and long-term
results.

Aim

The
aim of this study was to retrospectively evaluate the results of premature
infants who underwent bedside surgery PDA ligation after a non-responding
medical closure therapy.

Methods

In
this retrospective study, the results of babies who underwent bedside surgical
PDA ligation with the diagnosis of HAPDA in the neonatal intensive care unit
(NICU) were evaluated retrospectively. 84 premature babies were included in the
study. Demographic characteristics, type and duration of pre- and postoperative
respiratory support, intraventricular hemorrhage and bronchopulmonary dysplasia
rates, hospital stay duration and mortality data were analyzed.

Results

84
premature infants were included in the study. In 61 infants (72.6%) closure
with medical treatment and surgical ligation in 23 infants (27.4%) were performed
with the diagnosis of HAPDA. The median operating age was 35 (25-46) days and
the median body weight on the day of surgery was 1150 g (870-1100 g). In the
group undergoing surgical ligation, a baby (4.3%) was lost about 60 days after
the administration, while 22 infants could be discharged. Respiratory support,
oxygen withdrawal and discharge time of the babies who needed ligation were
statistically significantly longer than those responding to medical treatment
(p <0.001). No complication related to surgery was observed in infants who
underwent bed ligand surgery.

Conclusions

The
prolonged patency of the ductus arteriosus in preterm infants is related to an
increased morbidity. Bedside PDA ligation in NICUs where there is no pediatric cardiovascular
surgery team should be kept in mind as an alternative safe method to reduce
PDA-related morbidity and mortality by preventing delay in treatment in
patients who do not respond to medical treatment.

 

Anahtar Kelimeler

premature, PDA

Medikal Tedaviye Yanıtsız Duktus Arteriosuslu Preterm İnfantların Tedavisinde Güvenli Bir Yöntem: Yatakbaşı Cerrahi ligasyon

Öz

Giriş:

Pretrematüre
bebeklerde, özellikle çok düşük doğum ağırlıklı (ÇDDA) olanlarda bakım
kalitesinin iyileşmesi sonucu sağ kalım oranlarının artması, prematürite
ilişkili morbiditelerde de artışa neden olmuştur. Bu morbiditelerden biri olan
patent duktus arteriozus (PDA) ve ilişkili komplikasyonların (konjestif kalp
yetmezliği, bronkopulmoner displazi, nekrotizan enterokolit, intrakranial
kanama ve ölüm gibi) uygun yönetimi, kısa ve uzun dönem sonuçların
iyileştirilmesi için çok önemlidir. Bu nedenle hemodinamik anlamlı PDA’nın (HAPDA)
zamanında ve etkin bir şekilde tedavi edilmesi önem kazanmaktadır.  

Amaç:

Bu çalışmada, HAPDA tanısıyla
uygulanan medikal kapatma tedavisine cevapsızlık sonrası yatakbaşı cerrahi PDA ligasyon
yapılan prematüre bebeklerin sonuçlarının retrospektif olarak değerlendirilmesi
amaçlanmıştır.

Metaryal ve Metod

Bu retrospektif
çalışmada, yenidoğan yoğun bakım ünitesinde (YYBÜ) HAPDA tanısıyla yatakbaşı cerrahi
PDA ligasyonu uygulanan bebeklerin sonuçları retrospektif olarak
değerlendirildi. Çalışmaya 84 prematüre bebek dahil edildi. Demografik
özellikler, ameliyat öncesi ve sonrası solunum desteğinin tipi ve süresi,
intraventriküler kanama ve bronkopulmoner displazi oranları, hastanede kalış
süresi ve mortalite verileri analiz edildi.

 

Bulgular

Çalışmaya
84 premature infant dahil edildi. HAPDA tanısıyla 61 (% 72.6) infantta medikal
tedaviyle kapatma, 23 (%27,4) infantta ise cerrahi ligasyon uygulandı.  Ameliyat edilme yaşı ortanca 35 (25-46) gün, ameliyat
gününde ortanca vücut ağırlığı 1150 gr (870-1100 gr) idi. Cerrahi ligasyon
uygulanan grupta, uygulamadan yaklaşık 60 gün sonra bir bebek (% 4,3)  kaybedilirken (sendromik infant), 22 bebek
taburcu edilebildi. Ligasyon ihtiyacı olan bebeklerin solunum destek, oksijen
kesilme ve taburculuk süreleri medikal tedaviye yanıt veren bebeklere göre
istatiksel olarak anlamlı uzun olduğu görüldü (p<0.001). Yatakbaşı cerrahi
ligasyonu yapılan bebeklerde izlemde cerrahiye bağlı komplikasyon izlenmedi.

Sonuç:                                                    

Anahtar Kelimeler

premature, PDA, yatakbaşı cerrahi ligasyon

Kaynakça

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