胎龄<28周早产儿动脉导管未闭的治疗进展

Progress in management of patent ductus arterious in preterm infants with gestational age of <28 weeks

摘要:

动脉导管未闭(PDA)是早产儿常见疾病,目前早产儿PDA 的自然发展过程仍未完全明确,PDA 发生的有些高危因素仍存在争议,对PDA 是否进行药物、手术干预,以及何时进行药物、手术干预仍存在争议。尽管已经有相当多的证据证实动脉导管持续开放可能有害,但目前尚缺乏关闭导管治疗方案的远期益处或害处的相关证据。大多数临床试验旨在评估短期导管开放对患儿的影响。目前尚无评估动脉导管持续开放对早产儿死亡率及并发症影响的临床试验。近年来PDA 治疗上最大的变化是减少对PDA 的治疗。该文重点总结胎龄<28 周早产儿PDA 的治疗策略。

Abstract:

Patent ductus arteriosus (PDA) is a common problem encountered in the early neonatal period, particularly in preterm infants. Optimal management of PDA in preterm infants remains controversial. Despite considerable historical and physiological data indicating a persistent PDA may be harmful, robust evidence of long-term benefits or harms from treatment is lacking. This has been equated to a lack of benefit but is also a reflection of the fact that many clinical trials were designed to assess the effects of short-term (2-8 days) rather than prolonged exposure to a PDA. No clinical trials have been designed to assess the effects of prolonged exposure of persistent PDA on morbidity and mortality of very premature infants. Significant changes in management of PDA, i.e., less treatment for PDA, have evolved in recent years. This paper reviews the current literature and evidence for treatment options and research progress of PDA in infants with gestational age of <28 weeks.