引用本文:杨 宁,李 翠.布洛芬直肠给药与口服给药治疗极低出生体重儿动脉导管未闭的疗效比较[J].中国临床新医学,2019,12(9):989-993.
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布洛芬直肠给药与口服给药治疗极低出生体重儿动脉导管未闭的疗效比较
杨 宁,李 翠
253014 山东,德州市人民医院儿科
摘要:
[摘要] 目的 比较布洛芬经直肠给药与口服给药治疗极低出生体重儿(VLBWI)血流动力学异常动脉导管未闭(hsPDA)的临床疗效及安全性。方法 选择2016-06~2018-12在德州市人民医院新生儿重症监护病房住院的符合hsPDA诊断的VLBWI 58例,按随机数字表法分为观察组和对照组,每组29例。观察组为直肠给药,对照组为经口给药,3剂为1疗程,首剂10 mg/kg,24 h及48 h后各予5 mg/kg,用药后24~48 h复查心脏彩超。如仍存在hsPDA予第2疗程布洛芬。比较两组患儿的治疗效果及不良反应。结果 观察组动脉导管未闭关闭率为89.7%,对照组关闭率为93.1%,两组差异无统计学意义(P>0.05)。两组在布洛芬治疗期间肺出血、脑室内出血(>Ⅱ度)、败血症、用药期间少尿、肺动脉高压、消化道出血及坏死性小肠结肠炎发生率方面差异无统计学意义(P>0.05)。用药期间对照组有4例发生消化道出血,观察组无消化道出血发生。观察组有5例发生坏死性小肠结肠炎,对照组8例,且1例死于肠穿孔术后。观察组在应用布洛芬期间喂养不耐受发生率低于对照组,差异有统计学意义(P<0.05)。两组患儿治疗结束后检测血尿素氮、肌酐、胱抑素、总胆红素、电解质、血小板等指标差异均无统计学意义(P>0.05)。两组住院时间、病死率比较差异无统计学意义(P均>0.05),出院前两组支气管肺发育不良、早产儿视网膜病变发生率比较差异无统计学意义(P均>0.05)。结论 直肠布洛芬给药安全、方便、简单,对治疗早产儿hsPDA与经口给药同样有效,可减少喂养不耐受、消化道出血、坏死性小肠结肠炎的发生。
关键词:  布洛芬  极低出生体重儿  动脉导管未闭  直肠
DOI:10.3969/j.issn.1674-3806.2019.09.15
分类号:R 72
基金项目:
Comparison of the curative effects between rectal and oral administration of ibuprofen on patent ductus arteriosus in infants with very low birth weight
YANG Ning, LI Cui
Department of Pediatrics, Dezhou People′s Hospital, Shandong 253014, China
Abstract:
[Abstract] Objective To compare the clinical efficacy and safety between rectal administration and oral administration of ibuprofen in treatment of haemodynamically significant patent ductus arteriosus(hsPDA) in infants with very low birth weight. Methods A total of 58 very low birth weight infants diagnosed with hsPDA were selected from the Neonatal Intensive Care Unit of Dezhou People′s Hospital during June 2016 and December 2018 and were randomly divided into observation group(n=29) and control group(n=29). The observation group received administration of ibuprofen by rectum, and the control group was administered orally. The first dose was 10 mg/kg, 3 doses for a treatment course. A dose of 5 mg/kg was given at 24 h and 48 h after treatment, respectively. The echocardiography re-examination was performed after treatment of 24~48 h. If hsPDA still existed, ibuprofen should be given for the second treatment course. The therapeutic effects and adverse reactions were compared between the two groups. Results There was no significant difference in the PDA closure rate between the observation group(89.7%) and the control group(93.1%)(P>0.05).There were no significant differences in the incidence rates of pulmonary hemorrhage, intraventricular hemorrhage(>degree Ⅱ), septicaemia, oliguria, pulmonary hypertension, gastrointestinal bleeding and necrotizing enterocolitis between the two groups during ibuprofen treatment(P>0.05).There were 4 cases of gastrointestinal bleeding in the control group and no gastrointestinal bleeding in the observation group. Necrotizing enterocolitis occurred in 5 cases in the observation group and 8 cases in the control group, and 1 case died after intestinal perforation. The incidence of feeding intolerance in the observation group was lower than that in the control group, and the difference between the two groups was statistically significant(P<0.05). After treatment, there were no significant differences in blood urea nitrogen, creatinine, cystatin, total bilirubin, electrolyte, platelet and other indicators between the two groups(P>0.05). There were no statistically significant differences in the length of hospital stay and mortality between the two groups(P>0.05). Before discharge, there were no significant differences in the incidence rates of bronchopulmonary dysplasia and retinopathy of prematurity between the two groups(P>0.05). Conclusion Rectal administration of ibuprofen is safe, convenient and simple. It is equally effective in treating premature hsPDA as oral administration, and can reduce the occurrence of feeding intolerance, gastrointestinal bleeding and necrotizing enterocolitis.
Key words:  Ibuprofen  Very low birth weight infants(VLBWI)  Patent ductus arteriosus(PDA)  Rectum