Patent ductus arteriosus in premature neonates.
Patent ductus arteriosus in premature neonates.
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DOI：
10.2165/11632870-000000000-00000
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发表时间：
2012-05-07
期刊：
影响因子：
11.5
通讯作者：
Maheshwari A
中科院分区：
文献类型：
--
作者：
Mezu-Ndubuisi OJ;Agarwal G;Raghavan A;Pham JT;Ohler KH;Maheshwari A
动脉导管持续通畅是早产儿发病和死亡的主要原因。在妊娠 28 周之前出生的婴儿中，具有显着血流动力学特征的动脉导管未闭 (PDA) 可导致心血管不稳定，加剧呼吸窘迫综合征，延长辅助通气的需要，并增加支气管肺发育不良、脑室内出血、肾功能不全、脑室内出血、 脑瘫和死亡率。在本文中，我们回顾了病理生理学、临床特征和血流动力学意义的评估，并对证据质量进行了严格的评估，以支持当前早产儿 PDA 的内科和外科治疗。吲哚美辛和布洛芬等环加氧酶抑制剂仍然是 PDA 药物治疗的主要药物，可用于预防和挽救治疗以实现 PDA 闭合。手术结扎也很有效，用于对药物治疗没有反应的婴儿。尽管药物和手术治疗均已证明对闭合导管有效，但这两种方法都会产生显着的副作用。由于一些早产儿的导管确实会自然闭合，因此对最有可能出现有症状的 PDA 的婴儿进行改进和早期识别可能有助于指导高危婴儿的治疗，并允许其他婴儿接受期待治疗。
Persistent patency of the ductus arteriosus is a major cause of morbidity and mortality in premature infants. In infants born prior to 28 weeks of gestation, a hemodynamically-significant patent ductus arteriosus (PDA) can cause cardiovascular instability, exacerbate respiratory distress syndrome, prolong the need for assisted ventilation, and increase the risk of bronchopulmonary dysplasia, intraventricular hemorrhage, renal dysfunction, intraventricular hemorrhage, cerebral palsy, and mortality. In this article, we review the pathophysiology, clinical features, and assessment of hemodynamic significance, and provide a rigorous appraisal of the quality of evidence to support current medical and surgical management of PDA of prematurity. Cyclo-oxygenase inhibitors such as indomethacin and ibuprofen remain the mainstay of medical therapy for PDA, and can be used both for prophylaxis as well as rescue therapy to achieve PDA closure. Surgical ligation is also effective and is used in infants who do not respond to medical management. Although both medical and surgical treatment have proven efficacy in closing the ductus, both modalities are associated with significant adverse effects. Because the ductus does undergo spontaneous closure in some premature infants, improved and early identification of infants most likely to develop a symptomatic PDA could help in directing treatment to the at-risk infants and allow others to receive expectant management.
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影响因子：
5.1
作者：
Couser, RJ;Ferrara, TB;Payne, NR
通讯作者：
Payne, NR
DOI：
10.1159/000092870
发表时间：
2006-01-01
期刊：
BIOLOGY OF THE NEONATE
影响因子：
--
作者：
Clyman, Ronald I.
通讯作者：
Clyman, Ronald I.
影响因子：
2.5
作者：
Drougia, A.;Giapros, V.;Andronikou, S.
通讯作者：
Andronikou, S.
影响因子：
2.9
作者：
Benitz, W. E.
通讯作者：
Benitz, W. E.
影响因子：
3.8
作者：
Christmann, V;Liem, KD;van de Bor, M
通讯作者：
van de Bor, M