支气管肺发育不良极早产儿合并肺静脉狭窄2例报告

doi:10.12372/jcp.2023.22e0665

摘要/Abstract

摘要：

目的探讨支气管肺发育不良极早产儿合并肺静脉狭窄（PVS）的临床特征和治疗结局。方法回顾性分析两例支气管肺发育不良合并PVS极早产儿的临床资料，并复习相关文献。结果两例极早产儿，胎龄分别为30⁺¹周和28⁺²周，均为小于胎龄儿，诊断为支气管肺发育不良伴肺动脉高压。病例1生后4月20天发现左侧PVS，经药物治疗无效后死亡。病例2生后3月发现左侧PVS，生后5月15天右上肺静脉也狭窄，行肺静脉球囊扩张介入术后肺动脉压下降出院；1月余后，患儿肺高压反复，心胸外科行肺静脉狭窄纠治术，术后肺静脉再次狭窄，家属放弃治疗后死亡。结论合并支气管肺发育不良伴肺动脉高压的极早产儿，动态复查心彩超时应特别注意评估肺静脉情况。PVS患儿扩肺血管药物治疗无效时，可尝试介入或外科手术干预，但总体死亡率较高。

关键词: 极早产儿, 肺静脉狭窄, 支气管肺发育不良, 肺动脉高压

Abstract:

Objective To investigate the clinical characteristics and treatment of pulmonary vein stenosis (PVS) in extremely premature infants with bronchopulmonary dysplasia. Methods The clinical characteristics of PVS in two extremely premature infants with bronchopulmonary dysplasia were retrospectively analyzed and the related literatures were reviewed. Results The two infants were both small for gestational age and the gestational age was 30⁺¹ weeks and 28⁺² weeks, respectively. They were diagnosed with bronchopulmonary dysplasia with pulmonary hypertension. Case 1 had left PVS at 4 months and 20 days after birth, and he died after ineffective drug treatment. Case 2 had left PVS at 3 months after birth, and right upper PVS was found at 5 months and 15 days after birth. She received pulmonary vein balloon dilation therapy and pulmonary hypertension improved. More than a month after discharge, PVS relapsed and she received PVS correction operation. However, pulmonary vein turned stenosis again, the parents gave up further treatment and she died later. Conclusions Echocardiography should be performed in extremely premature infants with bronchopulmonary dysplasia and pulmonary hypertension, and pulmonary vein need to be evaluated carefully. When vasodilator drug treatment is ineffective, intervention or surgical operation could be considered. However, the overall mortality rate is high.

Key words: extremely premature infant, pulmonary vein stenosis, bronchopulmonary dysplasia, pulmonary hypertension

王丽平, 尤优, 殷张华, 王依闻, 陈笋, 夏红萍. 支气管肺发育不良极早产儿合并肺静脉狭窄2例报告[J]. 临床儿科杂志, 2023, 41(4): 289-293.

WANG Liping, YOU You, YIN Zhanghua, WANG Yiwen, CHEN Sun, XIA Hongping. Pulmonary vein stenosis in extremely premature infants with bronchopulmonary dysplasia: a report of two cases[J]. Journal of Clinical Pediatrics, 2023, 41(4): 289-293.

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