早产儿动脉导管未闭的临床管理
Clinical Management of Patent Ductus Arteriosus in Preterm Infants
DOI: 10.12677/acm.2026.1641225, PDF,   
作者: 邹昀翰, 王建辉*：重庆医科大学附属儿童医院新生儿诊治中心，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，儿科学重庆市重点实验室，重庆
关键词: 动脉导管未闭；早产儿；血流动力学评估；保守治疗；药物治疗；手术治疗；Patent Ductus Arteriosus； Preterm Infants； Hemodynamic Assessment； Conservative Management； Pharmacotherapy； Surgical Treatment
摘要: 动脉导管未闭(Patent Ductus Arteriosus, PDA)一种相对常见的早产儿先天性心脏病，发生率与胎龄及出生体重呈负相关，胎龄 < 28周的超早产儿中发生率可达80%以上。血流动力学显著的PDA (hemodynamically significant PDA, hsPDA)持续存在与支气管肺发育不良(Bronchopulmonary Dysplasia, BPD)、坏死性小肠结肠炎(Necrotizing Enterocolitis, NEC)、脑室内出血及肺出血等严重并发症密切相关。近年来，随着越来越多的基础与临床研究的发表，各角度临床评估方案的提出，使PDA管理理念发生根本性转变——从“积极干预”走向“保守观察优先、精准筛选获益人群”的个体化管理策略。本文综合近年高质量循证证据，系统阐述早产儿PDA的遗传学基础、多模态血流动力学评估、治疗的优化选择、循证依据与最新进展，为临床精准管理提供支持。
Abstract: Patent ductus arteriosus (PDA) is a relatively common congenital heart disease in preterm infants, with an incidence inversely proportional to gestational age and birth weight. The incidence can exceed 80% in extremely preterm infants born at <28 weeks’ gestation. Persistent hemodynamically significant PDA (hsPDA) is closely associated with severe complications, including bronchopulmonary dysplasia (BPD), necrotizing enterocolitis (NEC), intraventricular hemorrhage, and pulmonary hemorrhage. In recent years, with the publication of an increasing number of basic and clinical studies and the development of various clinical assessment approaches, the paradigm of PDA management has undergone a fundamental shift—from “active intervention” toward individualized management strategies that prioritize conservative observation while precisely selecting beneficiaries for treatment. This review synthesizes recent high-quality evidence to systematically evaluate the genetic basis, multimodal hemodynamic assessment, optimized treatment options, evidence-based rationale, and latest advances in the management of PDA in preterm infants, providing support for evidence-based, precision clinical management.
文章引用：邹昀翰, 王建辉. 早产儿动脉导管未闭的临床管理[J]. 临床医学进展, 2026, 16(4): 58-67. https://doi.org/10.12677/acm.2026.1641225

参考文献

[1] Ambalavanan, N., Aucott, S.W., Salavitabar, A., Levy, V.Y., Eichenwald, E., Ambalavanan, N., et al. (2025) Patent Ductus Arteriosus in Preterm Infants. Pediatrics, 155, e2025071425. [Google Scholar] [CrossRef] [PubMed]
[2] Yokoyama, U., Minamisawa, S. and Ishikawa, Y. (2010) Regulation of Vascular Tone and Remodeling of the Ductus Arteriosus. Journal of Smooth Muscle Research, 46, 77-87. [Google Scholar] [CrossRef] [PubMed]
[3] Sampath, H.J., Krishnan, P., Trinh, V. and Parton, L.A. (2024) Genetic Foundation of Prostaglandin Metabolism Influences Patent Ductus Arteriosus Closure in Extremely Low Birth Weight Infants. American Journal of Perinatology, 42, 43-51. [Google Scholar] [CrossRef] [PubMed]
[4] Villamor, E., Borges-Luján, M. and González-Luis, G. (2023) Association of Patent Ductus Arteriosus with Fetal Factors and Endotypes of Prematurity. Seminars in Perinatology, 47, Article ID: 151717. [Google Scholar] [CrossRef] [PubMed]
[5] Willis, K.A. and Weems, M.F. (2018) Hemodynamically Significant Patent Ductus Arteriosus and the Development of Bronchopulmonary Dysplasia. Congenital Heart Disease, 14, 27-32. [Google Scholar] [CrossRef] [PubMed]
[6] Clyman, R.I. and Hills, N.K. (2023) Patent Ductus Arteriosus (PDA) and Pulmonary Morbidity: Can Early Targeted Pharmacologic PDA Treatment Decrease the Risk of Bronchopulmonary Dysplasia? Seminars in Perinatology, 47, Article ID: 151718. [Google Scholar] [CrossRef] [PubMed]
[7] Gentle, S.J., Travers, C.P., Clark, M., Carlo, W.A. and Ambalavanan, N. (2023) Patent Ductus Arteriosus and Development of Bronchopulmonary Dysplasia–associated Pulmonary Hypertension. American Journal of Respiratory and Critical Care Medicine, 207, 921-928. [Google Scholar] [CrossRef] [PubMed]
[8] Ruoss, J.L., Bazacliu, C., Giesinger, R.E. and McNamara, P.J. (2020) Patent Ductus Arteriosus and Cerebral, Cardiac, and Gut Hemodynamics in Premature Neonates. Seminars in Fetal and Neonatal Medicine, 25, Article ID: 101120. [Google Scholar] [CrossRef] [PubMed]
[9] Schena, F., Francescato, G., Cappelleri, A., Picciolli, I., Mayer, A., Mosca, F., et al. (2015) Association between Hemodynamically Significant Patent Ductus Arteriosus and Bronchopulmonary Dysplasia. The Journal of Pediatrics, 166, 1488-1492. [Google Scholar] [CrossRef] [PubMed]
[10] Mirza, H., Garcia, J., McKinley, G., Hubbard, L., Sensing, W., Schneider, J., et al. (2019) Duration of Significant Patent Ductus Arteriosus and Bronchopulmonary Dysplasia in Extremely Preterm Infants. Journal of Perinatology, 39, 1648-1655. [Google Scholar] [CrossRef] [PubMed]
[11] Veldhuis, M.S., Dix, L.M.L., Breur, J.M.P.J., de Vries, W.B., Koopman, C., Eijsermans, M.J.C., et al. (2024) Role of Patent Ductus Arteriosus in Preterms in Long-Term Outcome. Early Human Development, 190, Article ID: 105953. [Google Scholar] [CrossRef] [PubMed]
[12] 江倩男, 刘婷婷, 刘莹莹, 等. 动脉导管未闭严重程度在胎龄 ≤ 32周早产儿肺出血发生和死亡中的预测价值[J]. 实用医学杂志, 2025, 41(10): 1575-1583.
[13] 孔祥博, 宋昊, 秦璠玥, 等. 基于动脉自旋标记技术探讨动脉导管未闭对极早产儿后期脑灌注的影响[J]. 发育医学电子杂志, 2025, 13(3): 175-181.
[14] McNamara, P.J. and Sehgal, A. (2007) Towards Rational Management of the Patent Ductus Arteriosus: The Need for Disease Staging: Table 1. Archives of Disease in Childhood—Fetal and Neonatal Edition, 92, F424-F427. [Google Scholar] [CrossRef] [PubMed]
[15] 中华医学会围产医学分会围产影像学组. 床旁功能性超声心动图评估早产儿动脉导管未闭血流动力学专家共识(2025) [J]. 中华新生儿科杂志(中英文), 2026, 41(1): 2-10.
[16] Karimi, M.R., Bischoff, A.R., Riley, E., Zerwic, L., McNamara, P.J., Hyland, R.M., et al. (2024) Echocardiographic Evaluation of Left Atrial Volume and Comparative Analysis to Left Atrial to Aortic Root Ratio in Premature Neonates and Infants with Patent Ductus Arteriosus. Echocardiography, 41, e15890. [Google Scholar] [CrossRef] [PubMed]
[17] Moronta, S.C., Bischoff, A.R., Ryckman, K.K., Dagle, J.M., Giesinger, R.E. and McNamara, P.J. (2024) Clinical and Echocardiography Predictors of Response to First-Line Acetaminophen Treatment in Preterm Infants with Hemodynamically Significant Patent Ductus Arteriosus. Journal of Perinatology, 44, 379-387. [Google Scholar] [CrossRef] [PubMed]
[18] Kulkarni, M., Gokulakrishnan, G., Price, J., Fernandes, C.J., Leeflang, M. and Pammi, M. (2015) Diagnosing Significant PDA Using Natriuretic Peptides in Preterm Neonates: A Systematic Review. Pediatrics, 135, e510-e525. [Google Scholar] [CrossRef] [PubMed]
[19] Zhang, Y., Gao, S. and Ju, R. (2025) Treatment Status and Progress of Patent Ductus Arteriosus in Extremely Low Gestational Age New-Borns and Extremely Low Birth Weight Infants. Journal of Clinical Research, 38, 146-150.
[20] Semberova, J., Sirc, J., Miletin, J., Kucera, J., Berka, I., Sebkova, S., et al. (2017) Spontaneous Closure of Patent Ductus Arteriosus in Infants ≤ 1500 g. Pediatrics, 140, e20164258. [Google Scholar] [CrossRef] [PubMed]
[21] Rolland, A., Shankar-Aguilera, S., Diomandé, D., Zupan-Simunek, V. and Boileau, P. (2014) Natural Evolution of Patent Ductus Arteriosus in the Extremely Preterm Infant. Archives of Disease in Childhood—Fetal and Neonatal Edition, 100, F55-F58. [Google Scholar] [CrossRef] [PubMed]
[22] Clyman, R.I., Liebowitz, M., Kaempf, J., Erdeve, O., Bulbul, A., Håkansson, S., et al. (2019) PDA-TOLERATE Trial: An Exploratory Randomized Controlled Trial of Treatment of Moderate-To-Large Patent Ductus Arteriosus at 1 Week of Age. The Journal of Pediatrics, 205, 41-48.e6. [Google Scholar] [CrossRef] [PubMed]
[23] Hundscheid, T., Onland, W., Kooi, E.M.W., Vijlbrief, D.C., de Vries, W.B., Dijkman, K.P., et al. (2023) Expectant Management or Early Ibuprofen for Patent Ductus Arteriosus. New England Journal of Medicine, 388, 980-990. [Google Scholar] [CrossRef] [PubMed]
[24] Gupta, S., Subhedar, N.V., Bell, J.L., et al. (2024) Selective Early Treatment versus Expectant Management of Patent Ductus Arteriosus in Preterm Infants: The Baby-OSCAR Trial. Archives of Disease in Childhood. Fetal and Neonatal Edition, 109, F123-F130.
[25] Buvaneswarran, S., Wong, Y.L., Liang, S., Quek, S.C. and Lee, J. (2025) Active Treatment vs Expectant Management of Patent Ductus Arteriosus in Preterm Infants. JAMA Pediatrics, 179, 877-885. [Google Scholar] [CrossRef] [PubMed]
[26] Parikh, N.A. and Velu, S. (2026) Patent Ductus Arteriosus: Emerging Trial Evidence Firmly Supports Conservative Management in Preterm Infants. Current Opinion in Pediatrics, 38, 200-206. [Google Scholar] [CrossRef] 
[27] Mitra, S., de Boode, W.P., Weisz, D.E. and Shah, P.S. (2023) Interventions for Patent Ductus Arteriosus (PDA) in Preterm Infants: An Overview of Cochrane Systematic Reviews. Cochrane Database of Systematic Reviews, 4, CD013588. [Google Scholar] [CrossRef] [PubMed]
[28] Clyman, R.I., Hills, N.K., Liebowitz, M. and Johng, S. (2019) Relationship between Duration of Infant Exposure to a Moderate-To-Large Patent Ductus Arteriosus Shunt and the Risk of Developing Bronchopulmonary Dysplasia or Death before 36 Weeks. American Journal of Perinatology, 37, 216-223. [Google Scholar] [CrossRef] [PubMed]
[29] Deng, Y., Zhang, H., Zhao, Z., Du, J., Bai, R. and McNamara, P.J. (2022) Impact of Patent Ductus Arteriosus Shunt Size and Duration on Risk of Death or Severe Respiratory Morbidity in Preterm Infants Born in China. European Journal of Pediatrics, 181, 3131-3140. [Google Scholar] [CrossRef] [PubMed]
[30] Ohlsson, A., Walia, R. and Shah, S.S. (2020) Ibuprofen for the Treatment of Patent Ductus Arteriosus in Preterm or Low Birth Weight (or Both) Infants. Cochrane Database of Systematic Reviews, 2, CD003481. [Google Scholar] [CrossRef] [PubMed]
[31] Ohlsson, A. and Shah, P.S. (2020) Paracetamol (Acetaminophen) for Patent Ductus Arteriosus in Preterm or Low Birth Weight Infants. Cochrane Database of Systematic Reviews, 12, CD010061. [Google Scholar] [CrossRef] [PubMed]
[32] Mitra, S., Florez, I.D., Tamayo, M.E., Mbuagbaw, L., Vanniyasingam, T., Veroniki, A.A., et al. (2018) Association of Placebo, Indomethacin, Ibuprofen, and Acetaminophen with Closure of Hemodynamically Significant Patent Ductus Arteriosus in Preterm Infants: A Systematic Review and Meta-Analysis. JAMA, 319, 1221-1238. [Google Scholar] [CrossRef] [PubMed]
[33] Edison, P.E., Chen, S., Yeo, C.L., Allen, J.C., Poon, W.B., Baral, V.R., et al. (2021) Pharmacokinetics of Oral versus Intravenous Ibuprofen for Closure of Patent Ductus Arteriosus: A Pilot Randomised Controlled Study. Journal of Paediatrics and Child Health, 58, 397-403. [Google Scholar] [CrossRef] [PubMed]
[34] Xiao, D., Jin, Y., Zhang, M., Di, X., Fu, L., Jiang, C., et al. (2023) Chiral Pharmacokinetics of Ibuprofen Enantiomers in Chinese Preterm Neonates with Patent Ductus Arteriosus Using a Validated UHPLC-MS/MS Method. Journal of Chromatography B, 1227, Article ID: 123765. [Google Scholar] [CrossRef] [PubMed]
[35] Kaur, S., Manerkar, S., Mondkar, J., Kalamdani, P., Patra, S. and Kalathingal, T. (2023) The Dilemma of Feeding during the Treatment of Patent Ductus Arteriosus with Oral Ibuprofen in Preterm Infants ≤ 30 Weeks of Gestation—A Randomized Controlled Trial. Journal of Perinatology, 43, 203-208. [Google Scholar] [CrossRef] [PubMed]
[36] Olowoyeye, A., Nnamdi-Nwosu, O., Manalastas, M. and Okwundu, C. (2022) A Network Meta-Analysis of Intravenous versus Oral Acetaminophen for Patent Ductus Arteriosus. Pediatric Cardiology, 44, 748-756. [Google Scholar] [CrossRef] [PubMed]
[37] Schindler, T., Smyth, J., Bolisetty, S., Michalowski, J., Mallitt, K., Singla, A., et al. (2021) Early Paracetamol (EPAR) Trial: A Randomized Controlled Trial of Early Paracetamol to Promote Closure of the Ductus Arteriosus in Preterm Infants. Neonatology, 118, 274-281. [Google Scholar] [CrossRef] [PubMed]
[38] Bouazza, N., Cambonie, G., Flamant, C., Rideau, A., Tauzin, M., Patkai, J., et al. (2023) Prophylactic Intravenous Acetaminophen in Extremely Premature Infants: Minimum Effective Dose Research by Bayesian Approach. Pediatric Drugs, 26, 83-93. [Google Scholar] [CrossRef] [PubMed]
[39] Ystrom, E., Gustavson, K., Brandlistuen, R.E., Knudsen, G.P., Magnus, P., Susser, E., et al. (2017) Prenatal Exposure to Acetaminophen and Risk of ADHD. Pediatrics, 140, e20163840. [Google Scholar] [CrossRef] [PubMed]
[40] Bauer, A.Z., Kriebel, D., Herbert, M.R., Bornehag, C. and Swan, S.H. (2018) Prenatal Paracetamol Exposure and Child Neurodevelopment: A Review. Hormones and Behavior, 101, 125-147. [Google Scholar] [CrossRef] [PubMed]
[41] Eras, Z., Uras, N., Canpolat, F., Erdeve, O., Oguz, S. and Oncel, M. (2017) Neurodevelopmental Outcomes of Preterm Infants Treated with Oral Paracetamol versus Ibuprofen for Patent Ductus Arteriosus. American Journal of Perinatology, 34, 1185-1189. [Google Scholar] [CrossRef] [PubMed]
[42] Jasani, B., Weisz, D.E., Reese, J. and Jain, A. (2023) Combination Pharmacotherapy for Patent Ductus Arteriosus: Rationale and Evidence. Seminars in Perinatology, 47, Article ID: 151720. [Google Scholar] [CrossRef] [PubMed]
[43] Clyman, R., Cassady, G., Kirklin, J.K., Collins, M. and Philips, J.B. (2009) The Role of Patent Ductus Arteriosus Ligation in Bronchopulmonary Dysplasia: Reexamining a Randomized Controlled Trial. The Journal of Pediatrics, 154, 873-876. [Google Scholar] [CrossRef] [PubMed]
[44] Weisz, D.E., Mirea, L., Rosenberg, E., Jang, M., Ly, L., Church, P.T., et al. (2017) Association of Patent Ductus Arteriosus Ligation with Death or Neurodevelopmental Impairment among Extremely Preterm Infants. JAMA Pediatrics, 171, 443-449. [Google Scholar] [CrossRef] [PubMed]
[45] Kabra, N.S., Schmidt, B., Roberts, R.S., Doyle, L.W., Papile, L. and Fanaroff, A. (2007) Neurosensory Impairment after Surgical Closure of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants: Results from the Trial of Indomethacin Prophylaxis in Preterms. The Journal of Pediatrics, 150, 229-234.e1. [Google Scholar] [CrossRef] [PubMed]
[46] Fonseca, E., Georgiev, S.G., Gorenflo, M. and Loukanov, T.S. (2013) Patent Ductus Arteriosus in Preterm Infants: Benefits of Early Surgical Closure. Asian Cardiovascular and Thoracic Annals, 22, 391-396. [Google Scholar] [CrossRef] [PubMed]
[47] Wang, H., Jain, A., Weisz, D.E. and Moraes, T.J. (2021) Trends in Patent Ductus Arteriosus Ligation in Neonates and Changes in Outcomes: A 10‐Year Multicenter Experience. Pediatric Pulmonology, 56, 3250-3257. [Google Scholar] [CrossRef] [PubMed]
[48] Lee, W.Y., Yum, S.K., Seo, Y., Kim, S., Shin, J.A. and Lee, C. (2024) Patent Ductus Arteriosus Management in Very-Low-Birth-Weight Prematurity: A Place for an Early Operation? European Journal of Cardio-Thoracic Surgery, 65, ezae123. [Google Scholar] [CrossRef] [PubMed]
[49] Sathanandam, S., Agrawal, H., Chilakala, S., Johnson, J., Allen, K., Knott-Craig, C., et al. (2019) Can Transcatheter PDA Closure Be Performed in Neonates ≤ 1000 Grams? The Memphis Experience. Congenital Heart Disease, 14, 79-84. [Google Scholar] [CrossRef] [PubMed]
[50] Seyam, O., Frishman, W.H. and Aronow, W.S. (2026) Contemporary Management Strategies for Patent Ductus Arteriosus. Cardiology in Review. [Google Scholar] [CrossRef] 
[51] 中华医学会儿科学分会心血管学组新生儿心脏病协作组, 中国医师协会心血管医师分会儿童心血管专业委员会, 中华儿科杂志编辑委员会. 极低或超低出生体重儿经导管动脉导管未闭封堵术专家共识(2025) [J]. 中华儿科杂志, 2025, 63(5): 477-483.
[52] Liu, J., Gao, W., Liu, Z., Zhao, K., Luo, G., Gao, S., et al. (2025) Transcatheter Patent Ductus Arteriosus Closure in Very Low Birth Weight Preterm Infants: Early Results and Midterm Follow-Up. Frontiers in Pediatrics, 13, Article 1650335. [Google Scholar] [CrossRef] [PubMed]
[53] Biouss, G., Antoun, L., Rahman, S., et al. (2025) Comparison of Neurodevelopmental Outcomes of Extremely Preterm Infants Under-Going Trans-Catheter Closure of the Patent Ductus Arteriosus Compared to Surgical Ligation. Journal of Perinatology, 45, 321-328.

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