Evans Nick
Department of Newborn Care, Royal Prince Alfred Hospital and University of Sydney, Sydney, New South Wales, Australia.
J Paediatr Child Health. 2012 Sep;48(9):753-8. doi: 10.1111/j.1440-1754.2012.02542.x.
Debate about the importance of the preterm patent ductus arteriosus (PDA) remains unresolved. Ultrasound studies of PDA have suggested that the haemodynamic impact may be much earlier after birth than previously thought, but we still do not know when to treat a PDA. Studies that have tested symptomatic or pre-symptomatic treatment are mainly historical and have not tested the effect of no treatment. Prophylactic treatment is the best studied regimen, but improvements in some short-term outcomes do not translate to any difference in longer term outcomes. Neonatologists have been reluctant to engage in trials that test treatment against not treating at all or very rarely. Targeting treatment on the basis of the early post-natal constrictive response of the duct is currently being tested as a possible strategy.
关于早产动脉导管未闭（PDA）的重要性的争论仍未解决。对PDA的超声研究表明，其血流动力学影响可能在出生后比以前认为的要早得多，但我们仍然不知道何时治疗PDA。测试有症状或症状前治疗的研究主要是历史性的，且未测试不治疗的效果。预防性治疗是研究最多的方案，但一些短期结果的改善并未转化为长期结果的任何差异。新生儿科医生一直不愿参与测试治疗与完全不治疗或极少治疗对比的试验。基于出生后早期导管收缩反应来靶向治疗目前正在作为一种可能的策略进行测试。
