目的 检验口服布洛芬治疗早产儿静脉导管未闭(PDV)的可行性。方法 选择2016年3月-2017年7月因“早产儿/新生儿黄疸”入院,生后24 h内经心脏彩超确诊为PDV的90例患儿为研究对象,随机分为治疗组和对照组,每组45例。治疗组出生后24 h内口服布洛芬混悬液,首剂为10 mg/kg,24 h、48 h后再分别给予5 mg/kg;对照组出生后2 h内口服生理盐水,首剂为1 ml/kg,24 h、48 h后再分别给予0.5 mg/kg。治疗前后分别检测两组患儿的总胆红素(TB)、直接胆红素(DBIL)、间接胆红素(IBIL)及血氨水平,治疗结束后复查两组患儿心脏彩超,观察两组患儿的治疗效果,以及治疗后的不良反应。结果 1)治疗组患儿静脉导管关闭率高于对照组(78.8% vs. 22.2%),差异有统计学意义(P＜0.01);2)治疗后治疗组的TB、IBIL及血氨低于对照组,差异有统计学意义(P＜0.01),两组的DBIL水平比较差异无统计学意义(P＞0.05);3)两组患儿大便隐血阳性率、颅内出血、坏死性小肠结肠炎、少尿、喂养不耐受等发生率差异均无统计学意义(P均＞0.05),血小板及肌酐水平比较差异均无统计学意义(P均＞0.05)。结论 口服布洛芬可有效促进PDV早产儿静脉导管闭合,且临床应用相对安全。
Abstract
Objective To test the feasibility of oral ibuprofen treatment in preterm infants with patent ductus venosus(PDV). Methods A total of 90 neonates hospitalized with neonatal jaundice and diagnosed with PDV by echocardiography within 24 hours after birth were enrolled in this study from March 2016 to July 2017.And participants were randomly divided into the treatment group(n=45) and control group(n=45).The treatment group was orally administered ibuprofen of 10 mg/kg within 24 hours after birth, followed 24 hours later by the second dose of 5 mg/kg and 48 hours later by the third dose of 5 mg/kg.While the control group was treated with placebo(normal saline) of 1 ml/kg, followed 24 hours later by the second dose of 0.5 ml/kg and 48 hours later by the third dose of 0.5ml/kg.The total bilirubin (TB), direct bilirubin (DBIL), indirect bilirubin (IBIL) and serum ammonia levels were tested before and after treatment in two groups.The two groups were examined by echocardiography after treatment, also the efficacy and adverse reactions of the two groups were observed after treatment. Results 1)The rate of closure of ductus venosus in the treatment group was significantly higher than that in the control group (77.8% vs.22.2%, P＜0.01).2)The levels of TB, DBIL, IBIL and blood ammonia after treatment in the treatment group were significantly lower than those in the control group (P＜0.01).3) In terms of adverse reactions,the differences on positive rate of fecal occult blood, the rates of intracranial hemorrhage, necrotizing enterocolitis,oliguria and feeding intolerance between two groups were not significant (all P＞0.05).Also, the levels of platelet and creatinine in two groups were not significantly different (P＞0.05). Conclusion Oral administration of ibuprofen can effectively promote the closure of PDV with clinical application of relative safety.
关键词
布洛芬 /
静脉导管未闭 /
婴儿 /
早产
Key words
ibuprofen /
patent ductus venosus /
infants /
premature
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