布洛芬治疗不同胎龄早产儿动脉导管未闭的效果分析

张可刚　李洁　孙波

[摘要]目的 探讨布洛芬治疗不同胎龄早产儿动脉导管未闭（PDA）的效果。方法 选择2013年11月～2016年10月我院NICU收治的2427例早产儿为研究对象。按患儿的胎龄分为10组：<28周15例、28周43例、29周81例、30周156例、31周267例、32周336例、33周359例、34周457例、35周371例、36周342例。给予有血流动力学影响的PDA（hsPDA）患儿口服布洛芬治疗3 d，首次10 mg/kg，24、48 h后改为5 mg/kg，治疗后1～2 d复查心脏彩超。统计动脉导管的闭合率，观察布洛芬的副作用。结果 2427例早产儿中hsPDA患儿203例，各胎龄组患儿的闭合率分别为：<28周63.6%，28周71.4%，29周74.1%，30周77.1%，31周80.4%，32周82.1%，33周89.5%，34周92.3%，35周100.0%，36周100.0%；17例患儿产生了药物副作用，其中消化道出血4例，胃潴留7例，腹胀2例，少尿4例。结论 布洛芬治疗不同胎龄早产儿PDA，胎龄越小，PDA闭合率越低，胎龄越大，闭合率越高，且副作用便于观察及处理，值得临床推广应用。

[关键词]胎龄；动脉导管未闭；早产儿；布洛芬

[中图分类号] R725.4 [文献标识码] A [文章编号] 1674-4721（2017）03（b）-0084-03

[Abstract]Objective To explore the curative effect of oral Ibuprofen in different gestational ages （GA） premature infants with patent ductus arteriosus （PDA）.Methods The premature infants of gestational age<37 weeks for 2427 cases were examined by Doppler ultrasound in our hospital from November 2013 to October 2016，and they were divided into ten groups by different gestational ages：15 cases<28 weeks，43 cases of 28 weeks，81 cases of 29 weeks，156 cases of 30 weeks，267 cases of 31 weeks，336 cases of 32 weeks，359 cases of 33 weeks，457 cases of 34 weeks，371 cases of 35 weeks，342 cases of 36 weeks，and each premature infant with a hemodynamically significant patent ductus arteriosus （hsPDA） was treated by oral Ibuprofen.The course of treatment was 3 days.They were given Ibuprofen 10 mg/kg，then Ibuprofen 5 mg/kg after 24 and 48 hours，and they were examined by Doppler ultrasound when one or two days after the treatment.The rate of artery catheter closure was counted，and the side effects of Ibuprofen was observed.Results There were 203 infants with hsPDA in 2427 premature infants.The closure rate of each group was 63.6% in less than 28 weeks，71.4% in 28 weeks，74.1% in 29 weeks，77.1% in 30 weeks，80.4% in 31 weeks，82.1% in 32 weeks，89.5% in 33 weeks，92.3% in 34 weeks，100.0% in 35 weeks，100.0% in 36 weeks.There were 17 cases with adverse reactions，including 4 cases of gastrointestinal bleeding，7 cases of gastric retention，2 cases of abdominal distension and 4 cases of oliguria.Conclusion In the treatment of PDA premature infants with different gestational age，Ibuprofen has the characteristic of the smaller of the gestational age，the lower closure rate of PDA，and the adverse reactions of Ibuprofen is easy to be observed and treated，it is worthy of clinical application.

[Key words]Different gestational age；PDA；Premature infants；Ibuprofen

目前新生儿重症监护室（neonatal intensive care unit，NICU）收治的早产儿越来越多，国内有大型综合医院的NICU收治的患者近2/3是早产儿。动脉导管未闭（patent ductus arteriosus，PDA）是治疗早产儿过程中常见的问题之一，早产儿胎龄越小，出生体重越低，PDA的发生率越高。国外研究显示，早产儿PDA的发生率达46%[1]，尤其是具有血流动力学影响的PDA（hemodynamic significant PDA，hsPDA），所引起的并发症对新生儿存活率及后遗症发生率有着显著的影响[2]。随着医疗救治水平的提高，存活的早产儿胎龄越来越小，早产儿胎龄跨度也越来越大，为了解口服布洛芬对不同胎龄hsPDA早产儿的疗效，笔者对其所在医院NICU收治的合并hsPDA的早產儿根据胎龄分组，并给予布洛芬治疗，观察其疗效，现报道如下。