布洛芬混悬液联合氢化可的松治疗早产儿动脉导管未闭的临床研究

Clinical study on Ibuprofen Suspension combined with hydrocortisone in treatment of patent ductus arteriosus in preterm infants

目的探讨布洛芬混悬液联合醋酸氢化可的松片治疗早产儿动脉导管未闭的临床疗效。方法选取2013年8月—2016年8月天津市蓟州区人民医院儿科收治的动脉导管未闭早产儿134例作为研究对象,依据患者治疗方式不同分为布洛芬组(44例)、氢化可的松组(44例)和联合组(46例)。布洛芬组口服布洛芬混悬液,首次剂量10 mg/kg,第2、3剂量5 mg/kg,每次间隔24 h,共3次。氢化可的松组口服醋酸氢化可的松片,1片/次,1次/d,治疗3 d。联合组给予布洛芬混悬液和醋酸氢化可的松片治疗,方法同上。观察3组的临床疗效,比较3组的前列腺素E2(PGE2)、N末端B型脑钠肽(NT-pro BNP)、内皮素-1(EF-1)和心功能指标。结果治疗后,布洛芬组、氢化可的松组和联合治疗组动脉导管未闭关闭率分别为84.09%、79.55%、93.48%,联合治疗组动脉导管未闭关闭率高于布洛芬组和氢化可的松组,3组比较差异有统计学意义(P<0.05)。治疗后,3组血浆PGE2、尿PGE2、NT-pro BNP和EF-1水平均明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且联合组这些观察指标明显低于布洛芬组和氢化可的松组,差异具有统计学意义(P<0.05)。治疗后,3组左心室收缩末前后径(LVESD)、左心室舒张末前后径(LVEDD)、左心室收缩末容量(LVESV)和左心室舒张末容量(LVEDV)均明显下降,同组治疗前后比较差异有统计学意义(P<0.05);且联合组这些观察指标明显低于布洛芬组和氢化可的松组,差异具有统计学意义(P<0.05)。联合组高胆红素血症、消化道出血发生率均低于布洛芬组和氢化可的松组,3组比较差异具有统计学意义(P<0.05)。结论布洛芬混悬液联合醋酸氢化可的松片治疗早产儿动脉导管未闭具有较好的临床疗效,降低了患儿PGE_2、NT-pro BNP、EF-1水平,改善患儿心功能指标,安全性较好,具有一定的临床推广应用价值。

Objective To investigate the clinical effect of Ibuprofen Suspension combined with Hydrocortisone Acetate Tablets in treatment of patent ductus arteriosus in preterm infants. Methods Premature infants with patent ductus arteriosus in Department of Neonatology of Jizhou District People＇s Hospital of Tianjin from August 2013 to August 2016 were enrolled in this study. According to the difference treatment plan, children were randomly divided into ibuprofen group （44 cases）, hydrocortisone group （44 cases）, and combined treatment group（46 cases）.Children in the ibuprofen group were po administered with Ibuprofen Suspension,the first dose 10 mg/kg, the second and third dose 5 mg/kg,time interval of 24 h,total 3 times.Children in the hydrocortisone group were po administered with Hydrocortisone Acetate Tablets, 1 tablet/time, once daily, treated for 3 d. Children in the combined treatment group were given Ibuprofen Suspension and Hydrocortisone Acetate Tablets. After treatment, the clinical efficacies were evaluated, and PGE2, NT-proBNP, EF-1, and cardiac function indexes in three groups were compared. Results After treatment, the patent ductus arteriosus closure rates in the ibuprofen, hydrocortisone, and combined treatment groups were 84.09%, 79.55%, and 93.48%, respectively, and the patent ductus arteriosus closure rates in the combined treatment group was higher than those in the ibuprofen and hydrocortisone groups, and there was difference among three groups （P 〈 0.05）. After treatment, the levels of plasma PGE2, urine PGE2, NT-proBNP, and EF-1 in three groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the combined treatment group were significantly lower than those in the ibuprofen and hydrocortisone groups, with significant difference between two groups （P 〈 0.05）. After treatment, LVESD, LVEDD, LVESV, and LVEDV in three groups were significantly decreased, and the difference was statistically significant in the same group （P 〈 0.05）. And the observational indexes in the combined treatment group were significantly lower than those in the ibuprofen and hydrocortisone groups, with significant difference between two groups （P 〈 0.05）. Incidences of hyperbilirubinemia and gastrointestinal bleeding in the combined treatment group were significantly lower than those in the ibuprofen and hydrocortisone groups, with significant difference between two groups （P 〈 0.05）. Conclusion Ibuprofen Suspension combined with Hydrocortisone Acetate Tablets has clinical curative in treatment of patent ductus arteriosus in preterm infants, can decrease the levels of PGE2, NT-proBNP, and EF-1, and improve cardiac function indexes, which has a certain clinical application value.