摘要
目的观察口服布洛芬对早产儿动脉导管未闭(PDA)的疗效及不同奶量喂养下消化道症状的发生率。方法收集2012年1月至2015年12月在金华市中心医院新生儿重症监护室(NICU)住院的283例胎龄≤32周出生48小时确诊为PDA的早产儿行布洛芬治疗者为布洛芬组,并选取同期入院胎龄≤32周、出生48小时床旁超声多普勒证实存在PDA,且PDA直径>1.5mm,CVD评分总分≥3分的早产儿78例作为对照组。布洛芬组又根据第1剂布洛芬口服时的奶量喂养情况,将283例患儿分为禁食组(a)、10~<20m L·kg-1·d-1组(b)、20~<50m L·kg-1·d-1组(c)、50~<80m L·kg-1·d-1组(d)、≥80m L·kg-1·d-1组(e),并根据第1剂布洛芬口服时不同的奶量喂养情况,分析布洛芬口服后1周内消化道症状,如消化道出血、新生儿坏死性小肠结肠炎(NEC)、喂养不耐受等的发生率。结果经过1、2、3个疗程布洛芬口服治疗后,有效率分别为50.5%(143例))、20.1%(57例)和4.6%(13例),第1个疗程PDA的关闭率和有效率明显高于第2、3疗程(χ~2值分别为3.87、4.17和10.14、18.60,均P<0.05)。对照组于生后第14天时复查心脏彩超,PDA关闭16例(20.5%),好转12例(15.4%),手术38(48.7%)。布洛芬组与对照组比较,在PDA关闭率(χ~2=18.13)、好转率(χ~2=20.23)、手术率(χ~2=29.17)方面的差异均有统计学意义,均P<0.05。布洛芬口服后,消化道症状总发生率禁食组(a组)分别与各不同奶量喂养组(b、c、d、e组)间比较,差异均有统计学意义(χ~2=5.71~40.00,均P<0.05)。结论早产儿出生1周内发现并予布洛芬第1个疗程口服后,PDA关闭率明显高于第2、3个疗程。早期喂养,喂养量大的早产儿布洛芬口服后1周内,消化道出血、NEC的发生率较少。
Objective To observe the effect of oral ibuprofen on premature infants with patent ductus arteriosus（ PDA） and the incidence of digestive tract symptoms under different milk volume. Methods Totally 283 preterm infants diagnosed with PDA within 48 hours after birth and their gestational age≤32 weeks were collected in ibuprofen group with treatment of ibuprofen. They were admitted in neonatal intensive care unit（ NICU） of Central Hospital of Jinhua City during January 2012 to December 2015. Another 78 preterm infants with gestational age≤32 weeks admitted in the same period were selected in control group. They were confirmed with PDA（ diameter 〉1. 5mm and CVD score≥3） by ultrasound Doppler 48 hours after birth. According to milk volume in taking orally the first dose of ibuprofen,the cases in ibuprofen group were divided into fasting group（ group a）,10- 〈20 m L/（ kg·d） group（ group b）,20- 〈50 m L/（ kg·d）group（ group c）,50- 80 m L/（ kg·d） group（ group d） and ≥80m L/（ kg·d） group（ group e）. Meanwhile,the incidence of digestive tract symptoms [digestive tract hemorrhage,neonatal necrotizing enterocolitis（ NEC）,and feeding intolerance] in 1 week after oral ibuprofen was analyzed according to the different milk volume in taking orally the first dose of ibuprofen. Results After 1,2,3 courses of oral ibuprofen treatment,the effective rate was 50. 5%（ 143 cases）,20. 1%（ 57 cases） and 4. 6%（ 13 cases）,respectively. The PDA closure rate and effective rate in the first course were significantly higher than those in the second and third course（ χ^2value was 3. 87,4. 17,10. 14 and 18. 60,respectively,all P〈0. 05）. Echocardiography performed again at 14 day after birth for cases in the control group showed that there were 16 cases with PDA closure（ 20. 5%）,12 cases with improvement（ 15. 4%） and 38 cases undergoing surgery（ 48. 7%）. There were significant differences in closure rate,improving rate and surgery rate between ibuprofe
出处
《中国妇幼健康研究》
2017年第2期167-170,共4页
Chinese Journal of Woman and Child Health Research
关键词
婴儿
早产
动脉导管未闭
布洛芬
消化道症状
infant
premature
patent ductus arteriosus（PDA）
ibuprofen
digestive tract symptoms
