Patent ductus arteriosus: pathophysiology and management
Patent ductus arteriosus: pathophysiology and management
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DOI：
10.1038/sj.jp.7211465
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发表时间：
2006-05-01
影响因子：
2.9
通讯作者：
Clyman, R. I.
中科院分区：
文献类型：
--
作者：
Hermes-DeSantis, E. R.;Clyman, R. I.
早产儿妊娠28周前发生的动脉导管未闭(PDA)给治疗方案的类型和时机带来了许多挑战。动脉导管未闭会导致肺血流量增加，并重新分配到其他器官。几种并发症(即坏死性小肠结肠炎、颅内出血、肺水肿/出血、支气管肺发育不良和视网膜病变)与PDA的存在有关，但是否PDA对它们的发展负责仍不清楚。前列腺素抑制剂消炎痛是治疗PDA的有效药物。关于干预的最佳时机的问题--一旦出现明显的迹象和症状，就进行早期预防或治疗--几十年来一直困扰着医生。本文从证据和经验两方面进行了探讨。回顾了足月儿和早产儿之间的生理学比较，以及防止导致PDA永久性狭窄的必要级联事件的障碍。
Patent ductus arteriosus (PDA) in preterm newborns prior to 28 weeks of gestation has led to many challenges regarding the type and timing of treatment regimens. A PDA results in increased pulmonary blood flow and redistribution of flow to other organs. Several co-morbidities (i.e., necrotizing enterocolitis, intracranial hemorrhage, pulmonary edema/ hemorrhage, bronchopulmonary dysplasia, and retinopathy) are associated with the presence of a PDA, but whether or not a PDA is responsible for their development is still unclear. The prostaglandin inhibitor, indomethacin, is effective in the treatment of PDA. Questions regarding the optimal timing of the intervention - early prophylaxis or treatment, once signs and symptoms become evident - have challenged physicians for decades. Both evidence and experience are explored in this article. Comparative physiology between the full-term and preterm newborn and the barriers preventing the necessary cascade of events leading to permanent constriction of the PDA are reviewed.