| 摘要: |
| 目的:比较布洛芬不同给药策略治疗早产儿动脉导管未闭(PDA)的有效性和安全性。 方法:回顾性收集 2022 年 1 月至
2024 年 1 月温州市中心医院收治的诊断为有血流动力学意义的 PDA(hsPDA)并接受布洛芬治疗的早产儿 184 例,根据布洛芬
不同给药途径、给药剂量、给药时机、给药疗程等进行分组,分析布洛芬不同给药策略 PDA 关闭率和并发症发生率。 结果:布洛
芬静脉给药组 PDA 关闭率与口服给药组比较差异有统计学意义(P< 0. 05),坏死性小肠结肠炎(NEC)、支气管肺发育不良
(BPD)、早产儿视网膜病变(ROP)、颅内出血(IVH)、高胆红素血症、喂养不耐受(FI)等并发症发生率比较差异无统计学意义
(P>0. 05)。 布洛芬静脉给药组少尿、消化道出血发生率高于口服给药组(P<0. 05)。 口服给药组高剂量亚组和标准剂量亚组
PDA 关闭率、并发症发生率比较差异无统计学意义(P>0. 05)。 静脉给药组高剂量亚组 PDA 关闭率高于标准剂量亚组(P<0. 05),
BPD、IVH 发生率低于标准剂量亚组(P<0. 05)。 口服给药组和静脉给药组生后>7~14 天给药亚组 PDA 关闭率均高于生后>14 天
给药亚组(P<0. 05),口服给药组生后≤7 天给药亚组 NEC 发生率高于生后>7 ~ 14 天给药亚组(P<0. 05),FI 发生率高于生后>
14 天给药亚组(P<0. 05)。 静脉给药组生后≤7 天给药亚组消化道出血发生率高于生后>7~14 天给药亚组(P<0. 05)。 口服给
药组和静脉给药组 2 个疗程亚组 PDA 关闭率、ROP 发生率高于单疗程亚组(P<0. 05)。 结论:hsPDA 早产儿生后>7~14 天静脉
给药高剂量布洛芬、单疗程失败后重复第 2 疗程的治疗策略在提高 PDA 关闭率的同时又能保证安全性,可作为 PDA 优化给药
策略在临床上推广应用。 |
| 关键词: 布洛芬 动脉导管未闭 并发症 早产儿 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2025.02.010 |
|
| 基金项目:基金项目:2023 年温州市基础性科研项目,编号 Y2023927。 |
|
| Clinical Study on Different Administration Strategies of Ibuprofen in the Treatment of Premature Infantswith Patent Ductus Arteriosus |
| Zeng Jinjie
1
, Hou Qishu
2
, Ye Jifeng
2
, Tang Jinxin
1 |
| (1. Wenzhou Central Hospital, Zhejiang Wenzhou 325000, China; 2. The
Second Affiliated Hospital of Wenzhou Medical University, Yuying Children’s Hospital, Zhejiang Wenzhou 325000, China) |
| Abstract: |
| Objective: To compare the efficacy and safety of different administration strategies of ibuprofen in the treatment of premature
infants with patent ductus arteriosus (PDA). Methods: A total of 184 premature infants diagnosed with hemodynamically significant
patent ductus arteriosus ( hsPDA) and treated with ibuprofen were retrospectively collected from Wenzhou Central Hospital from Jan.
2022 to Jan. 2024. The closure rate of PDA and complication rate of ibuprofen were analyzed according to different routes of
administration, dosage, timing and duration of administration. Results: There was significant difference in closure rate of PDA between
ibuprofen intravenous administration group and oral administration group ( P < 0. 05). There were no significant differences in the
incidence of necrotizing enterocolitis (NEC), bronchopulmonary dysplasia ( BPD), retinopathy of prematurity (ROP), intracranial
hemorrhage ( IVH), hyperbilirubinemia and feeding intolerance ( FI) between ibuprofen intravenous administration group and oral
administration group (P>0. 05). The incidence of oliguria and gastrointestinal bleeding in the ibuprofen intravenous administration group
was significantly higher than that in oral administration group (P<0. 05). There were no significant differences in the closure rate of
PDA and incidence of complication between the high dose and standard dose subgroup of oral administration group ( P > 0. 05).
However, in intravenous administration group, the closure rate of PDA was higher in high dose subgroup than that in standard dose
subgroup (P<0. 05), and the incidence of BPD and IVH was significantly lower than that in standard dose subgroup (P<0. 05). Both in oral and intravenous administration groups, the closure rate of PDA in >7 to 14 d postnatal administration subgroup was higher than
that in >14 d postnatal administration subgroup (P< 0. 05). In oral administration group, the incidence of NEC in ⩽7 d postnatal
administration subgroup was significantly higher than that in >7 to 14 d postnatal administration subgroup (P<0. 05), the incidence of FI
in ⩽7 d postnatal administration subgroup was significantly higher than that in >14 d postnatal administration subgroup (P< 0. 05).
While in intravenous administration group, the incidence of gastrointestinal bleeding in ⩽7 d postnatal subgroup was significantly higher
than that in >7 to 14 d postnatal administration subgroup (P<0. 05). Both in oral and intravenous administration groups, the closure
rate of PDA and incidence of ROP in two-course subgroup was significantly higher than that in single-course subgroup ( P< 0. 05).
Conclusion: High dose ibuprofen was given intravenously from >7 to 14 d after birth and repeated the second course of treatment after a
single course of treatment failed, which could increase the closure rate of PDA while ensuring the safety, it can be used as optimal
treatment strategy for PDA in premature infants in clinical practice. |
| Key words: ibuprofen patent ductus arteriosus complication premature infants |
