Table of Contents

HK J Paediatr (New Series)
Vol 2. No. 1, 1997

HK J Paediatr (New Series) 1997;2:9-17

Feature Article

Patent Ductus Arteriosus in Preterm Infants
未成熟兒動脈導管未閉的診斷和治療

TF Yeh


Abstract

Patent ductus arteriosus (PDA) occurs frequently in premature infants. The overall incidence of clinical PDA reported in premature infants ranges from 18 to 80%. However, the incidence of clinical and subclinical PA detected by echocardiography can be as high as 90%. Significant PDA L→R shunt can complicate the clinical course of RDS, therefore significant PDA requires medical or surgical intervention. Although pharmacological or surgical closure of the ductus may be required, in some infants PDA may close spontaneously without specific therapy. Management of subclinical PDA remains controversial. Routine prophylactic use of indomethacin, either for prevention of PDA or IVH cannot be recommended at the present time until more follow up studies are available. Surgical ligation of the ductus may be indicated in infants who do not react to medical treatment, particularly infants of extreme low birth weight. This paper summarizes the diagnosis and the current management. Emphasis has been placed on pharmacological closure of the ductus using the prostaglandin inhibitor.

動脈導管未閉(PDA)的發生率在未成熟兒中頗高。文獻中報告的發生率在18到80%之間。但是由超聲心動圖測得的臨床/亞臨床動脈導管未閉的發生率可高達90%。嚴重的動脈導管未閉左→右分流可加重呼吸窘迫綜合症(RDS)的臨床過程,故需要內科/外科治療。

儘管PDA患兒可能需要藥物或手術關閉該導管,有些患兒的導管亦可自行關閉而無需任何特殊的治療。關於亞臨床症狀PDA的治療意見尚不一致。除非有更多隨訪資料可得,目前階段尚不宜提倡常規使用消炎痛(indomethacin)來預防PDA或腦室出血(intraventricular hemorrhage, IVH)。手術結紮導管可用於那些對內科治療無反應的患兒,尤其是極低出生體重兒。本文總結了目前診斷和治療方面的情況,並著重強調了使用前列腺素抑制劑關閉導管的問題。

Keyword : Indomethacin; Patent ductus arteriosus; Respiratory distress syndrome

 
 

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