口服布洛芬治疗早产儿动脉导管未闭的疗效

Effect of Oral Ibuprofen on Premature Patent Ductus Ateriosus

目的观察口服布洛芬治疗早产儿动脉导管未闭(PDA)的疗效及安全性。方法发生症状性PDA的早产儿22例,出生体质量(1426.59±355.74)g,胎龄(29.95±2.53)周。用口服布洛芬混悬滴剂治疗,布洛芬10 mg/kg,共3次,间隔24 h。用药期间监测心率、血压、氧饱和度、血糖、尿量、胆红素、电解质。治疗结束后复查肾功能、血常规、超声心动图、头颅B超。结果经治疗14例(63.63%)PDA关闭,疗效与出生体质量有关,出生体质量≥1500 g疗效好于出生体质量<1500 g(P<0.05)。3例(13.64%)在PDA关闭后发生再开放。13例(59.10%)患儿用药后出现一过性少尿[尿量<1 mL/(kg.h)],均发生于第1次给药后;治疗前肌酐和尿素水平与治疗后比较无显著性差异(P>0.05)。血小板治疗前后比较无显著性差异(P>0.05)。10例(45.56%)发生喂养不耐受,经减少喂养量或暂停喂养后均好转。结论口服布洛芬治疗早产儿PDA有一定疗效,且安全,使用方便,但尚需进行早产儿药代动力学研究及临床对照研究以明确其疗效,制定有效治疗方案。

Objective To investigate the efficacy and safety of oral Ibuprofen on premature patent ductus arteriosus（PDA）. Methods Twenty - two cases were included. The birth weight was（ 1426.59 ± 355.74） g,gestational age was （29.95 ± 2.53） weeks, Ibuprofen susperrsion was used with dosage 10 mg/kg for 3 times,and the interval was 24 hours. The heart rate,SaO2 ,blood pressure,blood sugar, urine output, bilirubin and electrolyte were monitored during the treatment. The renal function, CBC, echocardiography （ECG） and head ultrasound were repeated after the treatment. Results PDA was closed in 14 cases（63.63% ）. The efficacy was related with the birth weight. The efficacy in the preterm with birth weight ≥1500 g （90%） was better than that of the preterm with birth weight 〈 1500 g （41.46% ） （ P〈 0.05）. PDA reopened in 3 cases （ 13.64% ） after treatment. Oliguria [ urine output 〈 1 mL/（ kg·h） ] occurred in 13 cases （ 59.10 % ） after the first dose. The serum creatinine （48.58 ± 18.33 ） μmol/L and urea （ 5.66 ± 4.31 ） μmol/L after treatment did not show significant changes compared with those of pre - treatment [ （63.33 ± 14.10） μmol/L, （5.88 ± 3.73） p.rnol/L, P 〉0.05 ]. The difference of pre- treatment （174.42±50.46） × 10^9/L and post - treatment platelet va/ue （186.47 ± 60.70） × 10^9/L was not significant （P 〉 0.05 ）. Ten cases （45.56 % ） showed feeding intolerance, which was resolved by holding feeds or reducing volume. Conclusions Oral ibuprofen is effective in closing PDA in preterm infant. It is safe and easy to use. Further study regarding the pharrnacokinetics in preterm infant and case - control study are needed to confirm its efficacy and treatment.