Bhatt V, Nahata M C
College of Pharmacy, Ohio State University, Columbus 43210.
Clin Pharm. 1989 Jan;8(1):17-33.
The incidence, pathophysiology, and clinical findings of symptomatic patent ductus arteriosus (PDA) are reviewed, and the pharmacologic management of symptomatic PDA is discussed. Spontaneous closure of the ductus arteriosus (DA) usually occurs within four days after birth in most premature and full-term infants. The incidence of PDA is related to birth weight in premature infants and has been shown to decrease with an increase in birth weight. Clinical findings are reviewed. Prophylactic treatment in the first few hours after birth may not be needed in most premature infants. Treatment should be considered only if the ductus becomes symptomatic. Medical management consists of respiratory support, fluid restriction, diuretics, digoxin, and indomethacin. Respiratory support, fluid restriction, and diuretics are used as first-line treatment of symptomatic PDA. Digoxin cannot be recommended as part of first-line therapy, since its risks seem to outweigh the benefits in preterm infants. Indomethacin should be used only if other standard measures including fluid restriction and diuretic treatment fail. The mechanism of action, pharmacokinetics, adverse effects, and drug interactions of indomethacin are discussed. Symptomatic PDA can increase morbidity and mortality, especially in very low birth weight infants. Treatment of symptomatic PDA may decrease the morbidity associated with this condition.
本文回顾了有症状动脉导管未闭（PDA）的发病率、病理生理学及临床发现，并讨论了有症状PDA的药物治疗。大多数早产儿和足月儿的动脉导管（DA）通常在出生后四天内自然闭合。PDA的发病率与早产儿出生体重有关，且已表明随着出生体重增加而降低。文中回顾了临床发现。大多数早产儿在出生后头几个小时可能无需预防性治疗。仅当导管出现症状时才应考虑治疗。药物治疗包括呼吸支持、液体限制、利尿剂、地高辛和吲哚美辛。呼吸支持、液体限制和利尿剂用作有症状PDA的一线治疗。地高辛不建议作为一线治疗的一部分，因为其风险在早产儿中似乎超过益处。仅当包括液体限制和利尿剂治疗在内的其他标准措施无效时才应使用吲哚美辛。文中讨论了吲哚美辛的作用机制、药代动力学、不良反应及药物相互作用。有症状PDA可增加发病率和死亡率，尤其是极低出生体重儿。有症状PDA的治疗可能会降低与此病症相关的发病率。
