小于32孕周早产儿静脉用布洛芬治疗动脉导管未闭疗效及影响因素

Effect and Correlative Factors of Intravenous Ibuprofen Treatment on Patent Ductus Arteriosus in Premature Infants Less Than 32 Weeks of Gestational Age

目的:探讨小于32孕周早产儿(verypreterm,VP)静脉用布洛芬治疗动脉导管未闭(PDA)疗效及其影响因素。方法:回顾性分析87例静脉用布洛芬治疗PDA的VP。分为治疗成功组和失败组,比较两组间出生孕周、体重、新生儿临床危险指数(CRIB)、治疗前各系统疾病、超声心动图结果、诊断和开始治疗的日龄、疗程和其他治疗等情况。结果:治疗1个疗程、追加1～2次剂量和第2疗程后成功率分别为42.52%(37/87)、68.97%(10/87)和75.86%(66/87)。出生孕周、体重、CRIB>5、治疗前重度呼吸窘迫综合征(NRDS)、肾功能不全发生率、动脉导管直径与体重比、左心房与主动脉根部内径比、首次用药时间等指标两组间差异有统计学意义(P<0.05)。但二分类Logistic回归中发现仅出生体重、CRIB和NDRS情况对PDA的关闭效果有影响。结论:VP中低出生体重和NRDS会降低PDA布洛芬治疗成功率。

Objective：To evaluate the effect and correlative factors of intravenous ibuprofen in treatment of patent ductus arteriosus（PDA）in very preterm（VP）less than 32 weeks of gestational age.Methods：Retrospective study was performed on 87 intravenous ibuprofen treated VPs who had been divided into＂success＂and＂failure＂groups.The two groups were compared in birth gestational age,weight,Clinical Risk Index for Babies（CRIB）,complications and ultrasound cardiogram outcomes before the treatment,course of treatment and additional therapies.Results：The achievemient ratios after 1st course,1～2 dose supplement and 2ed course were respectively 42.52%（37/87）,68.97%（10/87）and 75.86%（66/87）.Birth gestational age,weight,CRIB5,incidence rate of severe neonatal respiratory distress syndrome（NRDS）or renal insufficiency,ductus diameter/weight,left atrial/aortic root,date of first dose were different between the two groups（P0.05）.But Binary Logistic Regression found only birth weight,CRIB and NRDS were the correlative factors.Conclusions：Low weight and NRDS after birth could decrease the effect of ibuprofen on PDA.