Department of Pediatrics, Mount Sinai Hospital, Toronto, Canada; Department of Pediatrics, University of Toronto, Toronto, Canada.
Respiratory Therapy, Mount Sinai Hospital, Toronto, Canada.
Semin Fetal Neonatal Med. 2018 Aug;23(4):225-231. doi: 10.1016/j.siny.2018.05.001. Epub 2018 May 5.
The transition from intrauterine to extrauterine life represents a critical phase of physiological adaptation which impacts many organ systems, most notably the heart and the lungs. The majority of term neonates complete this transition without complications; however, dysregulation of normal postnatal adaptation may lead to acute cardiopulmonary instability, necessitating advanced intensive care support. Although not as well appreciated as changes in vascular resistances, the shunt across the DA plays a crucial physiologic role in the adaptive processes related to normal transitional circulation. Further, we describe key differences in the behavior of the ductal shunt during transition in preterm neonates and we postulate mechanisms through which the DA may modulate major hemodynamic complications during this vulnerable period. Finally, we describe the conditions in which preservation of ductal patency is a desired clinical goal and we discuss clinical factors that may determine adequate balance between pulmonary and systemic circulation.
从宫内到宫外的生命转变代表了一个关键的生理适应阶段，影响许多器官系统，尤其是心脏和肺部。大多数足月新生儿都能顺利完成这一过渡，没有并发症；然而，正常的产后适应失调可能导致急性心肺不稳定，需要先进的重症监护支持。尽管不如血管阻力的变化那么明显，但动脉导管分流在与正常过渡循环相关的适应性过程中起着至关重要的生理作用。此外，我们描述了早产儿过渡期间动脉导管分流行为的关键差异，并提出了动脉导管可能在这一脆弱时期调节主要血流动力学并发症的机制。最后，我们描述了保持动脉导管通畅是一个理想的临床目标的情况，并讨论了可能决定肺循环和体循环之间适当平衡的临床因素。
