布洛芬对PDA伴呼吸窘迫综合征新生儿血清cTnT和CK-MB的影响

Effects of ibuprofen on serum cTnT and CK-MB in neonates with patent ductus arteriosus induced by respiratory distress syndrome

目的研究布洛芬对新生儿呼吸窘迫综合征(NRDS)诱发动脉导管未闭(PDA)者血清心肌肌钙蛋白T(cTnT)和肌酸激酶同工酶(CK-MB)的影响及临床意义。方法呼吸窘迫综合征并PDA早产儿300例,随机分为观察组(使用布洛芬)和对照组(使用吲哚美辛),每组150例。观察2组患儿治疗前后血清CK-MB、cTnT、血小板计数、前列腺素E2(PGE2)、脑钠肽(NT-probe)水平,不良反应发生情况,临床改善时间及疗效,并分析cTnT、CK-MB与临床指标的相关性。结果2组治疗后cTnT及CK-MB水平明显降低,血小板计数明显升高,血浆PGE2水平及血清NT-probe水平明显降低(P<0.05),而2组治疗前比较,差异无统计学意义(P>0.05),观察组cTnT、CK-MB、血小板计数、血浆PGE2水平及血清NT-probe水平均明显低于对照组(P<0.05)。观察组不良反应发生率明显低于对照组(P<0.05),观察组临床改善时间低于对照组,治愈率及总有效率高于对照组,但差异无统计学意义(P>0.05)。血清cTnT水平与动脉导管直径呈正相关(r=0.10,P<0.05),CK-MB与性别、胎龄和分娩方式呈负相关(r值分别为-0.12、-0.23、-0.16,P<0.05),与出生体重呈正相关(r=0.15,P<0.05)。结论口服布洛芬治疗早产儿NRDS伴PDA安全有效,且对于NRDS伴PDA患儿可以有效改善其血清cTnT及CK-MB水平,值得临床推广应用。

Objective To investigate the effects and their clinical significance of ibuprofen on serum cTnT and CK-MB in neonates with patent ductus arteriosus(PDA)induced by respiratory distress syndrome(NRDS).Methods A total of 300 neonates with NRDS and PDA who were treated in our hospital from January 2015 to February 2018 were randomly divided into ibuprofen group(observation group)and indomethacin group(control group),with 150 cases in each group.The serum levels of CK-MB were detected by immunosuppressive method and electrochemiluminescence method,respectivelt.The serum levels of CK-MB and cTnT,and the changes of biochemical indexes before and after treatment were observed and compared between the two groups.Moreover the incidence of adverse reactions,the improvement time of clinical symptoms and clinical efficacy were observed and compared between the two groups.Results Before treatment there were no significant differences in the levels of cTnT,CK-MB,platelet,PGE2 and NT-probe between control group and observation group(P>0.05).After treatment,the levels of cTnT and CK-MB,plasma PGE2 and serum NT-probe were significantly decreased,however,the platelet levels were significantly increased in both groups,moreover,which in observation group were significantly lower than those in control group(P<0.05).In addition the incidence rate of adverse reactions in observation group was significantly lower than that in control group(P<0.05).The improvement time of clinical symptoms in observation group was lower than that in control group,and the cure rate and total effective rate in observation group were higher than those in control group,but there were no significant differences between the two groups(P>0.05).Moreover the serum levels of cTnT were positively correlated with ductus arteriosus diameter(P<0.05),however,the serum levels of CK-MB were negatively correlated with neonate’s sex,gestational age and delivery mode(P<0.05),however,which were positively correlated with birth weight(P<0.05).Conclusion The oral ibuprofen is safe and effective in treatment of NRDS and PDA in premature infants,which can effectively improve the serum levels of cTnT and CK-MB,thus,which is worthy of clinical application and promotion.