消炎痛和布洛芬口服及灌肠关闭早产儿动脉导管的疗效和安全性研究

Efficacy and safety of indomethacin and ibuprofen oral and lavation in closing ductus arteriosus in premature infants

目的观察分别使用消炎痛、布洛芬口服及灌肠治疗早产儿动脉导管未闭(PDA)的疗效及安全性,探讨治疗早产儿PDA的有效方法。方法择取我院2016年6月~2019年5月NICU收治的症状性PDA早产儿80例,依随机数字表法分为布洛芬口服组、布洛芬灌肠组、消炎痛口服组、消炎痛灌肠组各20例。治疗3 d后,观察各组患儿动脉导管关闭情况。结果动脉导管闭合,布洛芬口服组15例(75.00%)、布洛芬灌肠组16例(80.00%),消炎痛口服组13例(65.00%),消炎痛灌肠组5例(25.00%),布洛芬口服组、布洛芬灌肠组、消炎痛口服组以及消炎痛灌肠组间比较动脉导管闭合率,差异有统计学意义(P<0.05);四组患儿治疗过程中监测电解质、肾功、血小板、大便隐血试验、血清胆红素、凝血时间、血糖等生化指标比较,差异无统计学意义(P>0.05);四组患儿用药后无心率、血压、微循环改变,无少尿、大便隐血、皮下出血等改变,未发现喂养不耐受、NEC、肠穿孔等不良反应。结论在早产儿动脉导管未闭的治疗过程中使用布洛芬口服或灌肠的治疗方式,能够有效关闭动脉导管,而布洛芬灌肠法可以减少药物对胃黏膜的刺激,值得推广应用。

Objective To observe the efficacy and safety of indomethacin, ibuprofen oral and lavation in the treatment of PDA in preterm infants, and to explore an effective method for the treatment of PDA in premature infants. Methods80 premature infants with symptomatic PDA who were admitted to the NICU from June 2016 to May 2019 were enrolled. The patients were divided into the ibuprofen oral group, the ibuprofen lavation group, the indomethacin oral group and the indomethacin lavation group, according to the random number table method. 20 cases of indomethacin enema group. After 3 days of treatment, the patent ductus closure was observed among the groups. Results There were 15 patients(75.00%) in the ibuprofen oral group, 16 patients(80.00%) in the ibuprofen lavation group, 13 patients(65.00%) in the indomethacin oral group, and 5 patients(25.00%) in the indomethacin lavation group in terms of patent ductus closure up. The rates of arterial catheter closure among the ibuprofen oral group, the ibuprofen lavation group, the indomethacin oral group, and the indomethacin lavation group were significantly different(P<0.05). There were no significant differences in the electrolyte, renal function, platelet, fecal occult blood test, serum bilirubin, clotting time, blood glucose, etc monitored in four groups during treatment(P>0.05). There were no changes in heart rate, blood pressure and microcirculation changes, oliguria, fecal occult blood, subcutaneous hemorrhage in the four groups of children after medication. And no adverse reactions such as feeding intolerance, NEC, and intestinal perforation were found. Conclusion The use of ibuprofen oral or lavation in the treatment of patent ductus arteriosus in premature infants can effectively close the patent ductus, and ibuprofen lavation can reduce the stimulation of gastric mucosa, which is worthy of popularization and application.