布洛芬治療不同胎齡早產兒動脈導管未閉的效果分析

張可剛　李潔　孫波

[摘要]目的 探討布洛芬治療不同胎齡早產兒動脈導管未閉（PDA）的效果。方法 選擇2013年11月～2016年10月我院NICU收治的2427例早產兒為研究對象。按患兒的胎齡分為10組：<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。給予有血流動力學影響的PDA（hsPDA）患兒口服布洛芬治療3 d，首次10 mg/kg，24、48 h后改為5 mg/kg，治療后1～2 d復查心臟彩超。統計動脈導管的閉合率，觀察布洛芬的副作用。結果 2427例早產兒中hsPDA患兒203例，各胎齡組患兒的閉合率分別為：<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例患兒產生了藥物副作用，其中消化道出血4例，胃潴留7例，腹脹2例，少尿4例。結論 布洛芬治療不同胎齡早產兒PDA，胎齡越小，PDA閉合率越低，胎齡越大，閉合率越高，且副作用便于觀察及處理，值得臨床推廣應用。

[關鍵詞]胎齡；動脈導管未閉；早產兒；布洛芬

[中圖分類號] R725.4 [文獻標識碼] A [文章編號] 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

目前新生兒重癥監護室（neonatal intensive care unit，NICU）收治的早產兒越來越多，國內有大型綜合醫院的NICU收治的患者近2/3是早產兒。動脈導管未閉（patent ductus arteriosus，PDA）是治療早產兒過程中常見的問題之一，早產兒胎齡越小，出生體重越低，PDA的發生率越高。國外研究顯示，早產兒PDA的發生率達46%[1]，尤其是具有血流動力學影響的PDA（hemodynamic significant PDA，hsPDA），所引起的并發癥對新生兒存活率及后遺癥發生率有著顯著的影響[2]。隨著醫療救治水平的提高，存活的早產兒胎齡越來越小，早產兒胎齡跨度也越來越大，為了解口服布洛芬對不同胎齡hsPDA早產兒的療效，筆者對其所在醫院NICU收治的合并hsPDA的早產兒根據胎齡分組，并給予布洛芬治療，觀察其療效，現報道如下。