吲哚美辛治疗超低出生体重儿动脉导管未闭260例临床研究

Indomethacin treatment for patent ductus arteriosus in extremely low birth weight infants： A retrospective review of 260 cases

目的研究分析吲哚美辛治疗超低出生体重（ELBW）儿动脉导管未闭（PDA）的效果及其不良反应，以评估其在ELBW儿中的应用疗效和安全性。方法对1998～2004年住院的260例确诊存在有PDA并应用吲哚美辛治疗的ELBW儿进行回顾性分析。结果吲哚美辛治疗一个疗程后，PDA的关闭率为60．8％，两个疗程后为72．7％；最终总有效率为74．2％。需要外科手术结扎关闭为20．0％。吲哚美辛治疗中主要的不良反应包括血钠下降（25．4％）、轻微的出血倾向（22．5％）、少尿（15．4％）；极少部分患儿在治疗过程中出现疑似坏死性小肠结肠炎（2．0％）和颅内出血加重至3、4级（1．7％）。结论即使在发育极其未成熟的ELBW儿中，治疗性地静脉应用吲哚美辛对PDA仍然有良好的效果，且有较好的安全性和较少的不良反应。

Objective The incidence of patent ductus arteriosus （PDA） is high in extremely low birth weight （ELBW） infants. Indomethacin has been used widely in the prophylaxis and treatment of hemodynamically significant PDAs. The purpose of this study was to review the rate of ductus closure with indomethacin for PDA in ELBW infants, and the side effects associated with therapy. Methods We reviewed a cohort of 260 ELBW infants with PDA needing indomethacin treatment during a period of seven years from 1998 to 2004. Results The rate of ductus closure was 60.8 % after the first course indomethacin, and 72.7 % after the second course. In total 74.2 % of all PDAs were closed successfully with indomethacin, and only 52 infants （20.0%） required surgical ligation of the ductus. The side effects during therapy included hyponatremia （25.4 % ）, gastric bleeding （22.5 % ）, and oliguria （15.4 % ）. Necrotizing enterocolitis and a worsening intraventricular hemorrhage grade 3 or 4 occurred rarely during therapy, 2.0 % and 1.7 % respectively. Conclusion Indomethacin for PDA treatment was effective and safe even in ELBW infants.