Shimada Senji, Kasai Takeo, Hoshi Atsuki, Murata Atsushi, Chida Shoichi
Department of Pediatrics, Iwate Medical University, Morioka, Iwate, Japan.
Pediatr Int. 2003 Jun;45(3):255-62. doi: 10.1046/j.1442-200x.2003.01713.x.
Cardiocirculatory effects of hemodynamically significant patent ductus arteriosus (hsPDA) have not been systematically studied in extremely low-birth-weight (ELBW) infants with respiratory distress syndrome (RDS). The objective of the present study was to evaluate the effects of hsPDA on the left ventricular output (LVO) and organ blood flows in ELBW infants with RDS.
Extremely low-birth-weight infants (birth-weight <1000 g) treated with surfactant for RDS were studied by serial Doppler flow examinations. Doppler flow variables in 19 infants in whom hsPDA developed (hsPDA group) were compared with those in 19 infants without hsPDA matched for gestational age, birth-weight, and postnatal age (non-hsPDA group). All infants in the hsPDA group had pharmacologic closure of ductus arteriosus when hsPDA developed.
Before pharmacological closure of PDA, the hsPDA group had significantly higher LVO, lower blood flow volume of the abdominal aorta, and lower mean blood flow velocities in the celiac artery, superior mesenteric artery, and renal artery than the non-hsPDA group. These alterations in the hsPDA group reverted to the levels in the non-hsPDA group after the closure of PDA and had no deleterious effects on the cardiorespiratory status. No significant differences between the groups were found in mean blood flow velocities of the anterior cerebral artery throughout the study period.
These results indicate that although LVO is increased, the splanchnic and renal blood flows are decreased when hsPDA develops in ELBW infants with RDS. The effects of these alterations of LVO and organ blood flows on the cardiorespiratory course seem to be minor when early pharmacologic closure of PDA is done.
对于患有呼吸窘迫综合征（RDS）的极低出生体重（ELBW）婴儿，具有血流动力学意义的动脉导管未闭（hsPDA）对心脏循环的影响尚未得到系统研究。本研究的目的是评估hsPDA对患有RDS的ELBW婴儿左心室输出量（LVO）和器官血流的影响。
对接受表面活性剂治疗RDS的极低出生体重婴儿（出生体重<1000g）进行连续多普勒血流检查。将19例发生hsPDA的婴儿（hsPDA组）的多普勒血流变量与19例胎龄、出生体重和出生后年龄相匹配的无hsPDA婴儿（非hsPDA组）的进行比较。hsPDA组的所有婴儿在发生hsPDA时均进行了动脉导管的药物闭合。
在PDA药物闭合前，hsPDA组的LVO显著高于非hsPDA组，腹主动脉血流量较低，腹腔动脉、肠系膜上动脉和肾动脉的平均血流速度也较低。PDA闭合后，hsPDA组的这些改变恢复到非hsPDA组的水平，且对心肺状态无有害影响。在整个研究期间，两组之间大脑前动脉的平均血流速度无显著差异。
这些结果表明，虽然患有RDS的ELBW婴儿发生hsPDA时LVO增加，但内脏和肾脏血流减少。当早期进行PDA药物闭合时，LVO和器官血流的这些改变对心肺进程的影响似乎较小。
