Patent Ductus Arteriosus (PDA)动脉导管未闭

What is a patent ductus arteriosus (PDA)?什么是动脉导管未闭？

PDA is a heart problem that is usually noted in the first few weeks or months after birth. It is characterized by a connection between the aorta and the pulmonary artery which allows oxygen-rich (red) blood that should go to the body to recirculate through the lungs.

动脉导管未闭通常是在婴儿出生后最初几周或数月内发现的疾病。在主动脉和肺动脉之间（存在出生后本来应该关闭）的连接通道是其特点，政造成（部分）富含氧的鲜红色血液未能进入全身循环，而是经过此通道（动脉导管）再次回流到肺部，（增加心脏的负担）。

All babies are born with this connection between the aorta and the pulmonary artery. While your baby was developing in the uterus, it was not necessary for blood to circulate through the lungs because oxygen was provided through the placenta. During pregnancy, a connection was necessary to allow oxygen-rich (red) blood to bypass your baby's lungs and proceed into the body. This normal connection that all babies have is called a ductus arteriosus.

所有的孩子出生时在主动脉和肺动脉之间都有这个通道（动脉导管）。胎儿在子宫内发育的过程中，由于（母亲）通过胎盘提供（富）氧（血），血液不必通过肺部进行循环。怀孕期间，必须有（动脉导管作为肺动脉与主动脉之间的生理性）血流通道，使富氧血不经过胎儿肺部（直接）进入全身。所有胎儿都有的这种正常通道叫做动脉导管。

At birth, the placenta is removed when the umbilical cord is cut. Your baby's lungs must now provide oxygen to his/her body. As your baby takes the first breath, the blood vessels in the lungs open up, and blood begins to flow through to pick up oxygen. At this point, the ductus arteriosus is not needed to bypass the lungs. Under normal circumstances, within the first few days or weeks after birth, the ductus arteriosus closes and blood no longer passes through it. Most babies have a closed ductus arteriosus by 72 hours after birth.

出生时，切断脐带除去胎盘。婴儿的肺部必须开始为全身提供氧。随着婴儿啼哭（第一次呼吸运动）而肺部膨胀，血液开始流经肺部进行氧合。此时，（肺动脉血液就）不再需要经过动脉导管而直接注入肺脏。正常情况下，出生数日或数周后，动脉导管闭合，不再有血液通过。大多数婴儿在出生后72小时内动脉导管闭合。

In some babies, however, the ductus arteriosus remains open (patent) and becomes a problem, PDA. The opening between the aorta and the pulmonary artery allows oxygen-rich (red) blood to pass back through the blood vessels in the lungs.

然而，有些婴儿的动脉导管未闭合（持续开放）而形成疾病。主动脉与肺动脉之间的动脉导管未闭造成富氧血返回肺部。

PDA is the sixth most common congenital heart defect, occurring in 6 to 11 percent of all children with congenital heart disease. Patent ductus arteriosus occurs twice as often in girls as in boys.

动脉导管未闭在最常见的先天性心脏病中占第6位。在各种先天性心脏病中占6%~11%。女性的发生率是男性的2倍。

What causes patent ductus arteriosus?动脉导管未闭的发病原因是什么？

In many children, there is no known reason for the ductus arteriosus remaining open. However, PDA is seen more often in the following:

很多儿童的发病原因不明。然而，动脉导管未闭较常见于下列情况：

Some congenital heart defects may have a genetic link, either occurring due to a defect in a gene, a chromosome abnormality, or environmental exposure, causing heart problems to occur more often in certain families. Most often, a PDA occurs sporadically (by chance), with no clear reason for its development.

某些先天性心脏病可能有遗传因素，可能为基因缺陷、染色体异常，或造成心脏病的环境因素，较常发生在某些家庭。大多数情况下，动脉导管未闭是偶发性疾病，无明显病因。

PDA can also occur in combination with other heart defects.  动脉导管未闭也可合并其他先天性心脏病。

Why is PDA a concern?  动脉导管未闭（对人）有什么害处？

When the ductus arteriosus stays open, oxygen-rich (red) blood passes from the aorta to the pulmonary artery, mixing with the oxygen-poor (blue) blood already flowing to the lungs. The blood vessels in the lungs have to handle a larger amount of blood than normal. How well the lung vessels are able to adapt to the extra blood flow depends on how big the PDA is and how much blood is able to pass through it from the aorta.

如动脉导管持续开放，主动脉来的富氧血（通过动脉导管）进入肺动脉，与已经流入肺的乏氧血混合。肺血管必须比正常情况下接受更多量的血液。肺血管是否能够适应额外的血流，取决于动脉导管的粗细和从主动脉来的血流多少。 

Extra blood causes higher pressure in the blood vessels in the lungs. The larger the volume of blood that goes to the lungs, the higher the pressure. The lungs are able to cope with this extra blood flow and pressure for a while, depending on exactly how high the pressure is. Without medical treatment, however, the blood vessels in the lungs become diseased by the extra pressure.

额外的血流造成肺血管高压。进入肺的血流量越大，压力越高。肺能够应付额外血流和压力的时间长短，完全取决于压力有多高。如未经治疗，过高的压力则形成肺血管病变。

Further, because blood is pumped at high pressure through the PDA, the lining of the pulmonary artery will become irritated and inflamed. Bacteria in the bloodstream can easily infect this injured area, causing a serious illness known as bacterial endocarditis.

而且，由于高压血流通过动脉导管（泵入肺血管），肺动脉内膜受到刺激，出现炎症。血流内的细菌很容易损害部位的感染，引起称为细菌学心内膜炎的严重疾病。

What are the symptoms of a patent ductus arteriosus? 动脉导管未闭有哪些症状？

The size of the connection between the aorta and the pulmonary artery will affect the type of symptoms noted, the severity of symptoms, and the age at which they first occur. The larger the opening, the greater the amount of blood that passes through that overloads the lungs.

主动脉和肺动脉之间的动脉导管的粗细影响症状的类型和严重程度，以及开始出现症状的年龄。导管的口径越大，通过导管加重肺血管负荷的血流量越大。

A child with a small patent ductus arteriosus might not have any symptoms, and your child's physician may have only noted the defect by hearing a heart murmur. Other infants with a larger PDA may exhibit different symptoms. The following are the most common symptoms of PDA. However, each child may experience symptoms differently. Symptoms may include:

只有很细导管的儿童可能完全没有症状，医生只有听到心脏杂音才能发现疾病。动脉导管较粗的婴儿则可出现不同的症状。下面是动脉导管未闭的最常见的症状，不过，每个儿童可能出现不同的症状。这些症状包括：

The symptoms of a PDA may resemble other medical conditions or heart problems. Always consult your child's physician for a diagnosis.

动脉导管未闭的症状可能类似于其他疾病或心脏病。一定要请有关的医生做出诊断。

How is a patent ductus arteriosus diagnosed?  如何诊断动脉导管未闭？

Your child's physician may have heard a heart murmur during a physical examination, and referred your child to a pediatric cardiologist for a diagnosis. A heart murmur is simply a noise caused by the turbulence of blood flowing through the opening from the left side of the heart to the right.

医生可能在体检时听到心脏杂音，建议带孩子找儿科医生做出诊断。心脏杂音是血流从左心通过导管进入右心时产生的湍流引起的噪音。

A pediatric cardiologist specializes in the diagnosis and medical management of congenital heart defects, as well as heart problems that may develop later in childhood. The cardiologist will perform a physical examination, listening to the heart and lungs, and make other observations that help in the diagnosis. The location within the chest where the murmur is heard best, as well as the loudness and quality of the murmur (harsh, blowing, etc.) will give the cardiologist an initial idea of which heart problem your child may have. However, other tests are needed to help with the diagnosis, and may include the following:

儿科心脏病医生专门研究先天性心脏病和儿童期后一阶段发生的心脏病的诊断和内科治疗。儿科心脏病医生可进行体检，听诊心脏和肺部，进行有助于诊断的其他检查。在胸部最容易听到的杂音部位、响亮程度和性质（粗糙、吹风样，等）可以使心脏病医生得到孩子可能患有哪种心脏病的初步印象。不过，还需要其他一些检查辅助诊断，可能包括以下这些检查：

            心导管检查－－－心导管检查是一种侵入性检查方法，可获得心脏内部结构的详细资料。在镇静(药物作用)下，将柔韧的细导管插入腹

           股沟的血管，导入心脏。测定4个心腔和主动脉、肺动脉的压力和血氧。亦可注入造影剂更清楚地观察心脏内部的结构。   

Treatment for patent ductus arteriosus:  动脉导管未闭的治疗

Specific treatment for PDA will be determined by your child's physician based on:  您孩子的医生根据以下情况决定动脉导管未闭的特殊治疗方案：

A small patent ductus arteriosus may close spontaneously as your child grows. A PDA that causes symptoms will require medical management, and possibly even surgical repair. Your child's cardiologist will check periodically to see whether the PDA is closing on its own. If a PDA does not close on its own, it will be repaired to prevent lung problems that will develop from long-time exposure to extra blood flow. Treatment may include:

细的导管随着孩子的成长可能自然闭合。可引起症状的动脉导管需要内科治疗，以至于手术修复。您孩子的心脏病医生将要（为孩子）定期检查，观察导管能否自行闭合。如果不能自行闭合，则需要手术修复，以防由于长期肺部血流过多发生肺部病变（肺动脉高压）。治疗方法包括：

medical management  内科治疗

对早产儿，静脉（滴注）消炎痛可能有助于动脉导管的闭合。消炎痛（的作用）与阿司匹林和布洛芬有关，可刺激动脉导管壁的肌肉收缩，（促进）导管闭合。对于这种治疗方法还有什么问题，您孩子的医生会可以回答您。

As previously mentioned, some children will have no symptoms, and require no medications. However, others may need to take medications to help the heart and lungs work better. Medications that may be prescribed include the following:  如上所述，有些无症状的患儿不需要服药。但也有些患儿需要用药改善心肺功能。可用以下这些药物：

digoxin - a medicine that helps strengthen the heart muscle, enabling it to pump more efficiently.  地高辛---加强心肌收缩力的药物，使心脏的泵血功能更有效。

diuretics - the body's water balance can be affected when the heart is not working as well as it could. These medications help the kidneys remove excess fluid from the body.  利尿剂---如心脏功能不良，可影响全身水平衡。利尿剂可帮助肾脏排出体内过多的水分。

手术修复动脉导管的目的在于避免肺部由于血流量过多和压力过高而发生肺血管病变。6个月以内的婴儿如有引起症状（例如体重增加缓慢，呼吸急促）的粗大导管，一般适宜手术。没有症状的婴儿，往往可以推迟到年龄6个月以后手术。如果应该手术，您孩子的心脏病医生会提出建议。

Your child's PDA may be repaired surgically in the operating room or by a cardiac catheterization procedure. The surgical repair, also called PDA ligation, is performed under general anesthesia. The procedure involves closing the open PDA with stitches to prevent the surplus blood from entering your child's lungs.

您孩子的PDA可以在手术室内手术修复或通过心导管进行介入治疗。手术修复的方法也叫结扎术，是在全身麻醉下进行的。手术是用缝合线结扎PDA，防止过多的血液流入患儿的肺部。

The cardiac catheterization procedure may also be an option for treatment. During the procedure, the child is sedated and a small, thin, flexible tube (catheter) is inserted into a blood vessel in the groin and guided to the inside of the heart. Once the catheter is in the heart, the cardiologist will pass a special device, called a coil or occluder, into the open PDA preventing blood from flowing through it.

通过心导管进行的介入治疗也是一种可供选择的治疗方法。患儿在镇静药物作用下，将柔韧的细导管插入腹股沟部的血管，导入心脏内。一旦导管进入心脏，心脏病医生即可将一种特制的叫做堵闭器的装置送入导管内阻止血流经过。

Postoperative care for your child:  患儿手术后处理

Some children who undergo PDA ligation may need to spend some time in the intensive care unit after surgery. Others may return to a regular hospital room. Your child will be kept as comfortable as possible with medications which relieve pain or anxiety. The staff will also be asking for your input as to how best to soothe and comfort your child.

有些患儿在动脉导管结扎后可能需要在重症监护室内治疗一段时间。有些患儿可回到普通病房。使用缓解疼痛和焦虑的药物可尽量保持患儿舒适。医护人员也会要求家长配合，使患儿得到最大的慰藉和放松。

You will also learn how to care for your child at home before your child is discharged. The staff will give you instructions regarding medications, activity limitations, and follow-up appointments before your child is discharged. Most children will only need to stay in the hospital for a few days after the operation.

您也要在患儿出院前学会如何护理患儿。医护人员将会指导您用药、限制患儿的活动量，并约定随访时间。大多数患儿在手术后只需要住院数日。

Care for your child at home following PDA surgical repair:  动脉导管修复后的家庭护理

Most infants and older children feel fairly comfortable when they go home. Pain medications, such as acetaminophen or ibuprofen, may be recommended to keep your child comfortable. Your child's physician will discuss pain control before your child is discharged from the hospital.

大多数婴幼儿患者回家后都会感到相当舒适。推荐使用醋氨酚或布洛芬等止痛药保持患儿舒适。患儿的医生在出院前会（与您）讨论止痛的问题。

Often, infants who fed poorly prior to surgery have more energy after the recuperation period, and begin to eat better and gain weight faster.

手术前喂养困难的婴儿往往在渡过恢复期以后摄入较多能量，进食开始增多，体重增加较快。

After surgery, older children usually have a fair tolerance for activity. Your child will usually be allowed to play, while avoiding blows to the chest that might cause injury to the incision or breastbone. Within a few weeks, your child should be fully recovered and able to participate in normal activity.

手术后，年龄较大的儿童一般可承受较大的活动量。通常允许患儿玩耍，同时要避免胸部用力，以免损伤胸部切口或胸骨。数周内患儿应该完全康复，能够参加正常活动。

You will receive additional instructions from your child's physicians and the hospital staff.

您将会从患儿的医生和其他医护人员那儿得到更多的指导。

Long-term outlook after PDA surgical repair:  动脉导管修复后的长期效果：

In premature infants, the outlook after PDA surgical repair depends on the following: 早产儿动脉导管结扎后的效果取决于：

In children born full-term, most who had a patent ductus arteriosus repair will live healthy lives after recovering from the hospitalization. Activity levels, appetite, and growth should return to normal. Your child's cardiologist may recommend that antibiotics be given to prevent bacterial endocarditis for a specific time period after discharge from the hospital if the coil or occluder device was used.

足月妊娠后出生的动脉导管未闭患儿出院恢复后可健康生活。活动量、食欲和生长发育恢复正常。如为使用堵闭装置进行介入治疗的患儿，出院后建议使用一定时间的抗生素，预防细菌性心内膜炎。

Consult your child's physician regarding the specific outlook for your child.

有关您孩子的具体治疗效果，可咨询患儿的医生。

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