Treatment of patent ductus arteriosus: indomethacin or ibuprofen?
Treatment of patent ductus arteriosus: indomethacin or ibuprofen?
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DOI：
10.1038/jp.2008.52
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发表时间：
2008-05-01
影响因子：
2.9
通讯作者：
Corff, K. E.
中科院分区：
文献类型：
--
作者：
Sekar, K. C.;Corff, K. E.
早产儿持续性动脉导管未闭（PDA）如果在出生后第一周内不治疗，可导致严重的血流动力学变化，引起呼吸道、胃肠道和肾脏疾病。可用的治疗选择是保守方法、环氧合酶（考克斯）抑制剂药物治疗和手术结扎。在美国批准使用的考克斯抑制剂是吲哚美辛和布洛芬赖氨酸。这两种药物在关闭PDA方面同样有效。这两种制剂之间存在细微的差别。吲哚美辛对脑室内出血（IVH）的发生有保护作用，但会减少流向肾脏和大脑的血流量。碘油毒性较小，但对IVH无影响。药物治疗的疗效受治疗开始时间的影响。当药物治疗不能闭合有症状婴儿的PDA时，手术治疗是唯一的选择。长期的神经和呼吸系统疾病与手术结扎有关。本文综述了早产儿PDA治疗选择中的这些医学考虑。
Persistent patent ductus arteriosus (PDA) in preterm infants can result in serious hemodynamic changes causing respiratory, gastrointestinal and renal morbidities if not treated within the first week of life. The treatment options available are a conservative approach, pharmacological treatment with cyclo-oxygenase (COX) inhibitors and surgical ligation. The COX inhibitors approved for use in the United States are indomethacin and ibuprofen lysine. Both of these drugs are equally effective in closing the PDA. Subtle differences exist between these two preparations. Indomethacin has a protective effect on the incidence of intraventricular hemorrhage (IVH) but reduces the blood flow to the kidneys and the brain. Ibuprofen is less toxic but has no effect on IVH. Efficacy of pharmacological treatment is influenced by timing of initiation of therapy. Surgical treatment is the only option when pharmacological treatment fails to close the PDA in symptomatic infants. Long-term neurological and respiratory morbidities are associated with surgical ligation. This paper reviews these medical considerations in the treatment options for PDA in premature infants.