Morrow W R, Taylor A F, Kinsella J P, Lally K P, Gerstmann D R, deLemos R A
Department of Pediatrics, Wayne State University, Detroit, MI.
Crit Care Med. 1995 Jan;23(1):179-86. doi: 10.1097/00003246-199501000-00028.
To examine the effect of early ductal ligation vs. maintenance of ductal patency on vital organ perfusion and pulmonary function in premature baboons with hyaline membrane disease.
Randomized, controlled interventional study to compare early ligation with formalin infiltration of the ductus arteriosus.
Animal care facility at a dedicated research foundation.
Eighteen premature baboons delivered by hysterotomy at 140 +/- 2 day gestation.
Nine premature baboons underwent formalin infiltration of the ductus arteriosus (group 1), and nine underwent ductal ligation (group 2). Surgical ligation or formalin infiltration was performed at 2 to 4 hrs of age. Animals were maintained on mechanical ventilation and ventilator parameters were adjusted to maintain PaO2 and PaCO2 within the physiologic range.
Left ventricular output indexed to body weight and vital organ perfusion were measured at 24 hrs of age by the radiolabeled microsphere method. Lung mechanics, including lung wet/dry weight ratio, total lung water, static compliance and functional residual capacity were measured immediately following euthanasia.
Total pulmonary blood flow was significantly lower (p = .0001) in group 2 (mean = 94 mL/min/kg), compared with group 1 (mean = 287 mL/min/kg). Systemic blood flow and effective pulmonary blood flow were higher in group 1 (p = .07). No significant difference between groups in absolute organ blood flow was noted, although flow as a percent of left ventricular index was significantly higher in all organs except the kidney in group 2. There was no difference in arterial blood gas values, parameters of mechanical ventilation, percent lung water, or postmortem measurement of lung mechanics between groups.
Early ductal ligation did not result in improved cardiac output, increased organ blood flow, or improved pulmonary function. We postulate that gradual constriction of the ductus arteriosus may play an important role in successful cardiovascular adaptation in the premature infant. While it is clear that premature infants with symptomatic patent ductus arteriosus often benefit from ductal closure, we question the practice of prophylactic early ductal closure.
探讨早期动脉导管结扎与维持动脉导管通畅对患有透明膜病的早产狒狒重要器官灌注和肺功能的影响。
随机对照干预性研究，比较早期结扎与动脉导管福尔马林浸润的效果。
一家专门研究基金会的动物护理设施。
18只在妊娠140±2天通过剖宫产分娩的早产狒狒。
9只早产狒狒接受动脉导管福尔马林浸润（第1组），9只接受动脉导管结扎（第2组）。在出生后2至4小时进行手术结扎或福尔马林浸润。动物维持机械通气，调整呼吸机参数以维持动脉血氧分压（PaO2）和动脉血二氧化碳分压（PaCO2）在生理范围内。
在出生后24小时，采用放射性微球法测量以体重为指数的左心室输出量和重要器官灌注。在安乐死后立即测量肺力学指标，包括肺湿/干重比、肺总水量、静态顺应性和功能残气量。
与第1组（平均=287毫升/分钟/千克）相比，第2组（平均=94毫升/分钟/千克）的总肺血流量显著降低（p = 0.0001）。第1组的体循环血流量和有效肺血流量较高（p = 0.07）。两组间绝对器官血流量无显著差异，尽管第2组中除肾脏外所有器官的血流量占左心室指数的百分比显著更高。两组间动脉血气值、机械通气参数、肺水百分比或死后肺力学测量结果无差异。
早期动脉导管结扎并未导致心输出量改善、器官血流量增加或肺功能改善。我们推测动脉导管的逐渐收缩可能在早产婴儿成功的心血管适应中起重要作用。虽然有症状的动脉导管未闭早产婴儿通常受益于导管闭合是明确的，但我们对预防性早期导管闭合的做法提出质疑。
