Hermes-DeSantis E R, Clyman R I
Drug Information Service, Robert Wood Johnson University Hospital, Ernest Mario School of Pharmacy, Rutgers, The State University of New Jersey, New Jersey, USA.
J Perinatol. 2006 May;26 Suppl 1:S14-8; discussion S22-3. doi: 10.1038/sj.jp.7211465.
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.
孕28周前的早产新生儿动脉导管未闭（PDA）给治疗方案的类型和时机带来了诸多挑战。动脉导管未闭会导致肺血流量增加以及血流重新分布至其他器官。几种合并症（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）与动脉导管未闭有关，但动脉导管未闭是否是这些合并症发生的原因仍不明确。前列腺素抑制剂吲哚美辛在治疗动脉导管未闭方面有效。关于干预的最佳时机——是早期预防还是在体征和症状出现后进行治疗——几十年来一直困扰着医生。本文探讨了相关证据和经验。回顾了足月儿和早产儿之间的比较生理学以及阻碍导致动脉导管永久性收缩的必要事件级联发生的障碍。
