动脉导管未闭对早产儿的影响及其治疗措施研究进展  

Impact of PDA on preterm infants and research progress on its therapeutic interventions

作　　者：龙庆义 刘思佳 张秋月 LONG Qingyi;LIU Sijia;ZHANG Qiuyue(Department of Pediatrics,The First Affiliated Hospital of Hainan Medical University,Key Laboratory of Reproductive Health and Related Diseases Research and Transformation,Ministry of Education,Haikou 570100,China;不详)

机构地区：[1]海南医科大学第一附属医院儿科生殖健康及相关疾病研究与转化教育部重点实验室,海南海口570100 [2]海南医科大学第一临床医学院,海南海口570100 [3]海南省人类生殖与遗传重点实验室,海南海口570100 [4]海南省妇女儿童医学中心儿童保健科,海南海口570206

出　　处：《山东医药》2025年第3期130-133,149,共5页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(82060289)

摘　　要：动脉导管未闭(PDA)是儿童常见先天性心脏病之一,在早产儿中发生率较高。早产儿各器官系统发育不成熟,PDA对其影响较足月儿更为显著,可导致肺充血、肺水肿、支气管肺发育不良、肺动脉高压、艾森曼格综合征等呼吸系统和循环系统疾病,对早产儿的健康构成严重威胁。合理、合时的治疗是提高PDA早产儿生存率及生存质量的有效方法,主要治疗措施包括对症治疗、药物治疗、手术治疗及介入治疗。合理的液体摄入是最基本的对症治疗方法,必要时可予适量的利尿剂以减轻心脏的容量负荷。吲哚美辛、布洛芬及对乙酰氨基酚均可抑制前列腺素的合成,从而促进动脉导管的闭合,其疗效肯定,但其不良反应也不容忽视。部分PDA早产儿通过多疗程的药物治疗仍未闭合,且严重影响心肺功能,在无手术禁忌证的情况下,可通过手术结扎闭合,包括传统经左胸后外侧肋间动脉导管结扎术、经左前胸第二肋间小切口动脉导管结扎术以及床旁动脉导管结扎术。近年,经导管封堵术等介入治疗方案被逐渐应用于PDA的治疗,可避免开放性动脉导管结扎术的相关并发症,但在体质量及胎龄较低的早产儿中的应用受技术条件限制,需结合早产儿自身特点选择合适的设备装置,提高成功率。Patent ductus arteriosus(PDA)is one of the most common congenital heart diseases in children,with a higher incidence among preterm infants.Due to the immaturity of organ systems in preterm infants,PDA exerts more significant adverse effects compared with term infants,leading to respiratory and circulatory complications such as pulmonary congestion,pulmonary edema,bronchopulmonary dysplasia,pulmonary hypertension,and Eisenmenger syndrome,posing severe threats to their health.Appropriate and timely treatment is critical to improving the survival rate and quality of life in preterm infants with PDA.Primary therapeutic interventions include symptomatic management,pharmacotherapy,surgical procedures,and interventional therapies.Controlled fluid intake serves as the cornerstone of symptomatic treatment,with diuretics administered as needed to reduce cardiac volume overload.Medications such as indomethacin,ibuprofen,and acetaminophen inhibit prostaglandin synthesis to promote ductal closure,demonstrating confirmed efficacy,but their potential adverse effects require careful consideration.For preterm infants with PDA unresponsive to multiple courses of pharmacotherapy and experiencing severe cardiopulmonary compromise,surgical ligation becomes necessary in the absence of contraindications.Surgical approaches include the traditional posterolateral left thoracotomy for ductal ligation,minimally invasive left anterior second intercostal incision ligation,and bedside PDA ligation.In recent years,interventional therapies like transcatheter closure have been increasingly utilized for PDA treatment,offering advantages over open surgical ligation by minimizing complications.However,their application in preterm infants with extremely low body weight or gestational age remains technically challenging.Tailoring device selection to the unique anatomical and physiological characteristics of preterm infants is essential to enhance procedural success rates.

关 键 词：先天性心脏病 动脉导管未闭 早产儿 支气管肺发育不良 

分 类 号：R72[医药卫生—儿科]