早产儿动脉导管未闭管理及其争议

Management and controversy of patent ductus arteriosus of preterm infants

动脉导管未闭(PDA)是早产儿的特殊生理状态,其自发关闭率较高,但持续PDA开放,不仅导致一系列的并发症,还可增加患儿的死亡率。环氧化酶抑制剂吲哚美辛和布洛芬,其关闭PDA的疗效已被公认,但也引起心、脑、肾、肠的血流减少,布洛芬对器官血流的影响更小,特别是能降低坏死性小肠结肠炎(NEC)和一过性肾功能不全的发生率。手术结扎是目前关闭PDA的最确实方法,但仍存在发生单侧声带麻痹、气胸、乳糜胸及脊柱侧弯等并发症的潜在风险。

Patent ductus arteriosus （PDA） is a special physiological status of preterm infants and it has a high spontaneous closure incidence. Patent ductus arteriosus may not only induce a series of complications, but also increase the neonatal morbidity. The therapeutic effect of indomethacin and ibuprofen, which are cyclo-oxygenase inhibitors, on PDA has been recognized, but it may reduce the blood flow of heart, brain and kidney. Ibuprofen has little impact on the blood supply of organs, and it can particularly reduce the incidence for NEC and renal inadequacy. Surgical ligation is a certain therapy for PDA closure, but it is associated with an increased potential risk of direct complications, such as single side vocal cord paralysis, pneumothorax, chylothorax, and scoliosis.