Pladys P, Beuchée A, Wodey E, Tréguier C, Lassel L, Bétrémieux P
Neonatal Intensive Care Unit, University Hospital, Rennes, France.
Acta Paediatr. 2001 Mar;90(3):309-15.
To test the association between early disturbances in hemodynamics induced by left-to-right shunting through the duct and cystic periventricular leucomalacia.
Forty-six preterm infants (27-32 wk) admitted to the neonatal intensive care unit with risk criteria.
Patent ductus arteriosus was evaluated on days 1 and 4, and was significant (sPDA) in cases of absent or reversed end diastolic flow in the subductal aorta. Resistance index was measured in the anterior cerebral artery and in the subductal aorta.
Diagnosis of cystic periventricular leucomalacia between day 10 and day 50.
The 12 infants who developed cystic periventricular leucomalacia were compared with those who did not. On day 1, sPDA was more frequent (64% vs 26%; p = 0.03) in the cystic periventricular leucomalacia group, left ventricular output was higher (median = 341 vs 279 ml kg-1.min-1; p = 0.005), and rescue surfactant was more frequently used (83% vs 47%; p = 0.03). This latter association was confirmed by multivariate analysis. Resistance index in the anterior cerebral artery was increased in cases of significant patent ductus arteriosus (p < 0.01) and was correlated with resistance index in the subductal aorta.
On day 1 in this selected population, sPDA has an effect on blood flow velocity waveform in cerebral arteries and is associated with an increase in the emergence of cystic periventricular leucomalacia. This association could be casual rather than causal.
检测经动脉导管左向右分流引起的早期血流动力学紊乱与脑室周围白质软化症之间的关联。
46例符合风险标准的早产儿（27 - 32周）入住新生儿重症监护病房。
在第1天和第4天评估动脉导管未闭情况，若动脉导管下主动脉舒张期末血流消失或反向，则为显著动脉导管未闭（sPDA）。测量大脑前动脉和动脉导管下主动脉的阻力指数。
在第10天至第50天之间诊断脑室周围白质软化症。
将发生脑室周围白质软化症的12例婴儿与未发生者进行比较。在第1天，脑室周围白质软化症组中sPDA更为常见（64%对26%；p = 0.03），左心室输出量更高（中位数 = 341对279 ml·kg⁻¹·min⁻¹；p = 0.005），且更频繁使用抢救性表面活性剂（83%对47%；p = 0.03）。多因素分析证实了后一种关联。显著动脉导管未闭时大脑前动脉的阻力指数升高（p < 0.01），且与动脉导管下主动脉的阻力指数相关。
在这个特定人群中，第1天时sPDA对脑动脉血流速度波形有影响，且与脑室周围白质软化症的发生率增加有关。这种关联可能是偶然的而非因果关系。
