动脉导管未闭对早产儿冠状动脉血流的影响：一项前瞻性观察性初步研究。
The effect of patent ductus arteriosus on coronary artery blood flow in premature infants: a prospective observational pilot study.
作者信息
Vaisbourd Yulia, Sharif Dawod, Riskin Arieh, Yaniv Liat, Dinur Gil, Amen Khalil, Bader David, Kugelman Amir
机构信息
Department of Neonatology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Haifa, Israel.
Department of Cardiology, Bnai Zion Medical Center, Rappaport Faculty of Medicine, Haifa, Israel.
出版信息
J Perinatol. 2020 Sep;40(9):1366-1374. doi: 10.1038/s41372-020-0622-4. Epub 2020 Feb 20.
OBJECTIVE
To compare coronary flows between premature infants with and without hemodynamically significant patent ductus arteriosus (hsPDA) and to determine if coronary flow is influenced by medical PDA treatment.
DESIGN
Prospective, observational pilot study. Forty-three infants <32 weeks gestation underwent echocardiography when routinely indicated. Study group included infants with hsPDA requiring treatment. Comparison groups included infants with nonsignificant PDA and infants without PDA.
RESULTS
The study group (n = 13), compared with the comparison groups with nonsignificant PDA (n = 12) and without PDA (n = 18) had higher troponin levels (p = 0.003 and 0.004, respectively). In infants with hsPDA compared with infants with no PDA there was a significant increase in myocardial oxygen demand and decrease in left main coronary artery flow, with nonsignificant increase in cardiac output.
CONCLUSIONS
Decrease in coronary artery flows and higher troponin values may suggest a "steal effect," not allowing to meet the elevated myocardial oxygen demand in infants with hsPDA.
目的
比较有和没有血流动力学显著意义的动脉导管未闭（hsPDA）的早产儿之间的冠状动脉血流情况，并确定冠状动脉血流是否受药物性动脉导管未闭治疗的影响。
设计
前瞻性观察性试点研究。43例孕周小于32周的婴儿在常规检查时接受了超声心动图检查。研究组包括需要治疗的hsPDA婴儿。比较组包括动脉导管未闭不显著的婴儿和没有动脉导管未闭的婴儿。
结果
研究组（n = 13）与动脉导管未闭不显著的比较组（n = 12）和没有动脉导管未闭的比较组（n = 18）相比，肌钙蛋白水平更高（分别为p = 0.003和0.004）。与没有动脉导管未闭的婴儿相比，患有hsPDA的婴儿心肌需氧量显著增加，左冠状动脉主干血流减少，心输出量增加不显著。
结论
冠状动脉血流减少和肌钙蛋白值升高可能提示存在“窃血效应”，这使得hsPDA婴儿无法满足升高的心肌需氧量。
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