动脉导管未闭是早产儿（尤其是极早产儿）常见的心血管问题。持续性左向右分流可引起肺过度循环、左心容量负荷增加和体循环灌注不足，但单纯促进导管解剖关闭尚未证实能够改善主要临床结局。近年来，管理理念逐步由常规关闭转向依据血流动力学效应和临床风险实施选择性干预。该文综述了不同管理策略的适用范围、证据边界及风险分层管理思路，为临床决策和后续研究提供参考。

Patent ductus arteriosus is a common cardiovascular problem in preterm infants, particularly those born very preterm. Persistent left-to-right shunting may cause pulmonary overcirculation, left-sided volume overload, and systemic hypoperfusion, yet simply promoting anatomical ductal closure has not been shown to improve major clinical outcomes. Management has increasingly shifted from routine closure toward selective intervention guided by hemodynamic effects and clinical risk. This review summarizes the applicability of different management strategies, the boundaries of current evidence, and a risk-stratified management approach, providing reference for clinical decision-making and future research.