布洛芬混悬液治疗新生儿动脉导管未闭疗效观察

目的探讨口服布洛芬混悬液治疗新生儿动脉导管未闭（PDA）的临床疗效。方法选择经心脏彩超确诊的53例PDA新生儿随机分成两组,治疗组27例,于出生后2~7 d分3次口服布洛芬混悬液治疗。结果治疗组动脉导管关闭率明显高于对照组,但两组相比χ2=2.621,P〉0.05,差异无统计学意义。其中布洛芬混悬液治疗后足月儿动脉导管关闭率稍高于早产儿,但差异无统计学意义（P〉0.05）。用药期间血清尿素氮和肌酐含量正常。结论口服布洛芬混悬液治疗新生儿动脉导管未闭,疗效好,且不良反应小。     

床旁超声心动图联合颅脑超声在早产儿动脉导管未闭临床监测中应用观察

目的:观察床旁超声心动图联合颅脑超声在早产儿动脉导管未闭(Patent ductus arteriosus,PDA)临床监测中的应用价值。方法:回顾性分析2016年11月至2017年11月我院新生儿重症监护室收治的268例早产儿PDA患儿临床资料,所有患儿均接受床旁超声心动图与颅脑超声检测,监测患儿PDA发生情况,观察并比较不同PDA患儿大脑中动脉(MCA)各血流参数指标水平,同时记录患儿PIVH发生情况。结果:根据患儿出生7d后超声心动图检查结果检出有血流动力学意义的PDA(hs-PDA)患儿73例,无血流动力学意义的PDA(nhsPDA)患儿195例;出生7d后,hsPDA患儿中导管关闭22例,未闭51例,关闭组患儿Vd、Vm水平均高于未闭组,PI、RI水平低于未闭组,差异有统计学意义(P0.05);两组Vs水平比较,差异无统计学意义(P0.05);hsPDA患儿与nhsPDA患儿PIVH检出率比较,差异无统计学意义(P0.05);但hsPDA组患儿重度PIVH检出率高于nhsPDA组,差异有统计学意义(P0.05)。结论:早产儿发生有意义的动脉导管未闭后将对其脑血流动力学参数产生影响,同时增加患儿发生重度PIVH的风险,早产儿出生后及时为其实施床旁超声心动图联合颅脑超声监测对疾病的早期检出有着重要意义,利于疾病早期干预与治疗,对患儿预后的改善有着重要的临床指导意义。     

超声心动图评价早产儿动脉导管关闭前后左心结构与功能变化

目的:探讨超声心动图评价早产儿动脉导管关闭前后左心结构与功能变化。方法:选取2021年1月至2022年5月于我院的动脉导管未闭早产儿90例,均给予布洛芬治疗,之后依据治疗结果分为动脉导管闭合组(n=67)和动脉导管未闭组(n=23),对两组的血流动力学参数、一般资料以及治疗前后的左心功能、结构变化情况。结果:两组的分娩方式相比差异无统计学意义(P>0.05),但动脉导管未闭组的出生体重、胎龄、峰值流速、压差均比动脉导管闭合组小,且动脉导管直径、LA/AO更高(P<0.05);动脉导管未闭组治疗后的流速、压差明显高于治疗前,而动脉导管直径明显低于治疗前(P<0.05),其他指标对比差异无统计学意义(P>0.05);动脉导管闭合组治疗后LA/AO、LVEDD、LAD明显低于治疗前,E/A和e’/a’比值明显高于治疗前(P<0.05),其他指标对比差异无统计学意义(P>0.05)。结论:动脉导管未闭的早产儿应用超声心动图评价效果较好,可以明确其心脏结构和功能的具体变化情况,且动脉导管关闭后通过超声心动图可以明显看到患儿的左心室功能有所改善,左心内经缩小,有...     

高频超声预测早产儿动脉导管早期自然关闭的价值

目的探讨高频超声预测早产儿动脉导管早期自然关闭的价值。方法170名早产儿（孕周〈37周）,均在出生后24h内入院,高频及常规超声心动图连续观察动脉导管,首次超声心动图检查于出生后24h内完成,以后每天随访观察至第7天,若此期间发现动脉导管已经闭合,则不再继续随访检查。其中16名早产儿动脉导管出生7d内未自然关闭,为动脉导管早期未自然关闭（早期PDA）组,另从7d内自然关闭组中随机选取32名早产儿作为对照组,分别采用高频探头及常规心脏探头测量动脉导管内径、左房前后径与主动脉根部内径比值（LA／AO）。结果早产儿动脉导管于24、48、72h内自然关闭率分别约18．8％（32／170）、61．2％（104／170）、78．8％（134／170）,7d内达90．6％（154／170）,即早产儿出生后早期动脉导管自然关闭率约90．6％（154／170）。高频超声对动脉导管二维及彩色血流长度完整显示率均高于常规超声[82％（39／48）w46％（22／48）,P〈0．001,100％（48／48）w77．1％（37／48）,P〈0．01],差异有统计学意义。高频超声测得早期PDA组动脉导管的内径大于对照组[（2．08±O．4）mm vs （1．09±0．22）mm,P〈0．001],以1．55mm为临界值,预测早生儿出生后7d内动脉导管自然关闭的敏感度、特异度分别为87．5％、90．6％,准确性为66．5％。结论高频超声能明确诊断早产儿PDA,在精确显示动脉导管结构上优于常规超声心动图：动脉导管内径越大,早期自然关闭可能性越小。     

布洛芬治疗早产儿动脉导管未闭53例的临床研究

目的探讨口服布洛芬治疗早产儿动脉导管未闭（PDA）的疗效以及安全性,同时研究相关因素对疗效影响。方法符合入选标准的PDA患儿53例给予口服布洛芬治疗,观察患儿动脉导管关闭情况以及不良反应。结果本组首次治疗有效率为84．91％,治疗失败者8例,经第2疗程治疗后有2例PDA关闭,因此,PDA关闭总有效率为88．68％。研究表明布洛芬的用药时间和患儿出生体重对PDA关闭率均有积极显著的影响,且无严重不良反应发生。结论布洛芬治疗早产儿动脉导管未闭疗效确切,用药安全。早期应用布洛芬,可显著提高早产儿的PDA关闭率。     

口服对乙酰氨基酚治疗早产儿动脉导管未闭的疗效观察

目的：观察对乙酰氨基酚对有布洛芬应用禁忌或口服布洛芬治疗失败的早产儿动脉导管未闭（PDA）的疗效及安全性。方法经床旁彩超确诊的有临床症状，同时口服布洛芬两个疗程 PDA 关闭失败或有应用布洛芬禁忌证的早产儿17例，口服对乙酰氨基酚每次15 mg/kg，q 6 h连用3 d，用药期间监测心率、血压、氧饱和度、血糖、尿量、经皮胆红素。治疗结束后复查肝功能、肾功能、血常规、血糖、心脏彩超、颅脑彩超。结果经治疗11例（64.7%）PDA关闭，治疗前后监测各项生化指标差异无统计学意义（P＞0.05）；5例轻度上消化道出血早产儿口服后PDA闭合3例（60%）。3例（17.6%）早产儿口服药物后出现一过性谷丙转氨酶升高，经保肝药物治疗2周后降至正常。结论对有布洛芬禁忌证或口服布洛芬治疗失败的早产儿，口服对乙酰氨基酚有一定疗效，且安全、便捷，可减少手术概率，但目前治疗仍需前瞻性、大样本、随机对照临床研究以明确疗效。     

动脉导管未闭对早产儿脑血流灌注影响的高频彩超研究

【】目的 研究动脉导管未闭(PDA)对早产儿早期脑血流灌注的影响。方法 将胎龄≤35周、出生体质量≤2200g,生后3天确诊为症状性PDA的早产儿,分为动脉导管开放组(PDA组)及药物关闭动脉导管组(对照组)。在生后6-7天内对入选的62例患儿(PDA组30例,对照组32例)应用高频超声结合E-flow血流显像技术,行超心动图和颅脑超声检查,测量大脑中动脉(middle cerebral artery, MAC)、豆纹动脉(Lenticulostriate artery, LSA)、豆纹动脉终末段(the terminal artery of Lenticulostriate artery, tLSA)的血流参数,包括收缩期峰值流速(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)、收缩期峰值流速与舒张末期速度比值(S/D)、阻力指数(RI)。采用t检验比较各组间的差别。 结果 入选的两组早产儿在胎龄及出生体质量方面差异无统计学意义。PDA组MCA、LSA、tLSA的Vd测值均明显低于对照组(P < 0.001),而上述三个阶段血管的血流S/D及RI均大于对照组,P < 0.001。两组早产儿MCA、LSA的Vs无明显差异(P > 0.05),而PDA组脑组织内细小血管tLSA的Vs则明显减低,P < 0.001。结论 高频超声结合E-flow显像技术可观察到合并PDA早产儿脑血流动力学改变,反应脑实质内细小动脉的低灌注、高阻力状态,为临床判断及积极干预PDA,稳定早产儿脑血流,避免脑损伤提供依据。     

早产儿动脉导管未闭诊疗进展

动脉导管未闭(PDA)在早产儿有较高发病率。临床症状和体征在早产儿PDA的诊断上缺乏特异性,超声心动图是目前诊断PDA特别是血流动力学改变显著的PDA(hsPDA)的重要手段。近期研究认为血清脑钠肽(BNP)和N-端脑钠肽原(NT-proBNP)可作为诊断hsPDA的生物标记物并指导早产儿PDA治疗策略的选择。早产儿PDA的治疗包括环氧酶(COX)抑制剂、吲哚美辛和布洛芬的药物疗法及外科结扎术。近期报道对乙酰氨基酚可作为对COX抑制剂不敏感或禁忌的早产儿治疗PDA的替代药物。经导管封堵在早产儿PDA的治疗上值得临床进一步研究。本文对早产儿PDA的诊疗进展作一综述。     

超声评估早产儿动脉导管未闭对脑血流灌注影响的研究

目的探讨超声评价早产儿动脉导管未闭(PDA)对脑血流灌注影响的应用价值。方法 62例症状性PDA的早产儿分为动脉导管开放组(PDA组)30例和药物关闭动脉导管组(对照组)32例。在产后6~7 d应用常规超声结合低速血流显像技术,对两组患儿行超心动图和颅脑超声检查,测量大脑中动脉(MAC)、豆纹动脉(LSA)及豆纹动脉终末段(t LSA)的血流参数,包括收缩期峰值流速(Vs)、舒张末期速度(Vd)、平均血流速度(Vm)、收缩期峰值流速与舒张末期流速比值(S/D)及阻力指数(RI);比较两组各参数的差别。结果 PDA组MCA、LSA、t LSA的Vd、Vm值均较对照组低,S/D、RI值均较对照组高,差异均有统计学意义(均P0.05);PDA组t LSA的Vs值较对照组低,差异有统计学意义(P0.05);两组MCA、LSA的Vs值比较差异无统计学意义。结论超声结合低速血流显像技术可观测PDA早产儿脑血流动力学改变,为临床判断和积极干预PDA提供依据。     

新生儿未闭动脉导管的超声检测

目的　动态观察新生儿动脉导管关闭的时间 ,新生儿动脉导管生理及病理特点 ,为临床早期诊断动脉导管未闭 (PDA)提供准确依据。方法　应用彩色多谱勒超声心动图对出生 2 4h～ 7d的新生儿 (Ⅰ组 )及 6月～ 3岁患儿 (Ⅱ组 )未闭的动脉导管的内径、收缩期最大血流速度进行测量 ,并比较测量结果 ,连续三次动态观察新生儿动脉导管关闭情况。结果　新生儿动脉导管多数可自然关闭 ,关闭时间多在 2 4～ 72h内 ,少数 3d后关闭。本组仅 1例经 4月的连续观察 ,动脉导管依然未闭。未闭的动脉导管内血流速度Ⅰ组与Ⅱ组比较有明显差异 (P <0 .0 0 1)。结论　多普勒超声心动图不仅能早期诊断PDA ,也可进行跟踪观察 ,动态检测动脉导管的关闭时间 ,对诊断PDA具有重要价值     

Ibuprofen pharmacokinetics in preterm infants with patent ductus arteriosus.

OBJECTIVE: Our objective was to study the pharmacokinetics of ibuprofen in premature infants with patent ductus arteriosus on day 3 and day 5 after birth. METHODS: Ibuprofen was administered on days 3, 4, and 5 by a 15-minute intravenous infusion of 10, 5, and 5 mg/kg, respectively, with the aim of closing the ductus arteriosus. Blood samples were drawn at time zero and at 0.5, 1, 2, 4, 12, and 24 hours after the first and third doses. Ibuprofen plasma concentrations were assayed by HPLC. RESULTS: A total of 27 premature infants were included (gestational age, 28.6 +/- 1.9 weeks; birth weight, 1250 +/- 460 g; values are mean +/- standard deviation). Ibuprofen pharmacokinetics followed a 2-compartment open model. Between the first and third doses (day 3 and day 5) there was a significant decrease of the volume of distribution of the central compartment (Vd(c)) (0.244 versus 0.171 L/kg; P =.03) and area under the plasma concentration-time curve (524 versus 447 mg. h/L; P =.01). The decrease in Vd(c) was most pronounced in patients with a closing ductus. Total body clearance and plasma half-life did not change significantly. No significant differences were observed in ibuprofen peak plasma concentrations after the first and third doses in relation to ductal status after treatment. CONCLUSION: Ibuprofen pharmacokinetics showed a large interindividual variation in premature infants during treatment for patent ductus arteriosus, and significant changes may occur between day 3 and day 5 after birth in those infants with a closing ductus. These findings may have implications for the treatment schedule with ibuprofen in patients with patent ductus arteriosus.     

The use of ibuprofen in neonates in the treatment of patent ductus arteriosus

Indomethacin has long been used to treat patent ductus arteriosus but it is associated with a relatively high risk of adverse effects; recent evidence suggests that ibuprofen is effective and may be safer. In a randomised trial to compare the efficacy and safety of ibuprofen and indomethacin in the treatment of patent ductus arteriosus, 144 infants received three doses of ibuprofen lysine (10, 5 and 5 mg/kg) at 24-hour intervals or indomethacin 0.2 mg/kg at 12-hour intervals. Ductal closure occurred in 70% of children treated with ibuprofen and 66% of those given indomethacin on the first treatment (P = 0.41). Nineteen children underwent surgical ligation, equally distributed between the treatment groups (P = 0.81). Urine production was significantly greater than in children given indomethacin from day 3 to day 7 and the serum creatinine concentration was significantly lower from day 7. Ductal closure was associated with higher serum concentrations of ibuprofen and a concentration of 10-12 mg/l appears to be the minimum level for efficacy. In a randomised, placebo-controlled, double-blind trial of prophylaxis with ibuprofen, the rate of patent ductus arteriosus associated with ibuprofen was 19% compared with 42% with placebo. Urine output was comparable in the two groups except on day 1, when it was significantly lower among infants given ibuprofen. Ibuprofen is therefore as effective as indomethacin in the treatment of patent ductus arteriosus, and effective as prophylaxis, in premature infants.     

Abnormal renal and splanchnic arterial Doppler pattern in premature babies with symptomatic patent ductus arteriosus

The flow velocity pattern in the descending aorta, renal arteries, and celiac and superior mesenteric arteries was studied with pulsed Doppler in eight premature babies with symptomatic ductus arteriosus before and after ductal closure, as compared to nine premature babies without ductus arteriosus. There was a decrease or reversal of flow in diastole in the above arteries in babies with ductus and diastolic flow reappeared after ductal closure. This diastolic steal phenomenon has not been previously demonstrated in the abdominal arteries. It may contribute to proneness to ischemic damage of abdominal organs in premature babies.     

Prenatal diagnosis of premature constriction of the ductus arteriosus with tricuspid papillary muscle rupture: a case report

We describe the case of a neonate who was prenatally diagnosed at a gestational age of 36 weeks with premature constriction of the ductus arteriosus. Blood from the thin ductus arteriosus flowed toward the pulmonary artery. Severe tricuspid regurgitation was also observed. We subsequently confirmed rupture of the tricuspid papillary muscle after birth. Cardiotonic drugs and nitric oxide were administered immediately at birth for pulmonary hypertension, and this therapy was continued until the seventh postnatal day. Emergency tricuspid valve repair was unnecessary, because there were no signs of severe circulatory insufficiency. This case suggests a relationship between prenatally diagnosed premature constriction of the ductus arteriosus and tricuspid papillary muscle rupture in neonates.     

超声心动图指标预测新生儿动脉导管自然关闭的价值

目的:探讨早期超声心动图指标能否预测新生儿动脉导管自然关闭。方法:足月新生儿在出生后3天内进行初次超声心动图检查,观察动脉导管是否已经闭合,若动脉导管未闭且没有其它畸形,则进行随访观察,随访超过12月未闭合者则认为是无法自然闭合的动脉导管未闭患者。1995年1月~2005年3月本院共有45例随访12月动脉导管尚未闭合的患者(PDA组),另随机选取50例3天内动脉导管已经闭合的小儿作为对照组(CONTROL组),比较两组间的超声心动图指标。结果:PDA组的左房?蛐主动脉比值(LA/AO)、左室?蛐主动脉比值(LVIDd/AO)、动脉导管彩色血流最细处宽度及动脉导管肺动脉侧左向右分流速度明显高于对照组(P值分别为:P<0.001,P<0.01,P<0.001,P<0.001)。LA/AO<1.30,LVIDd/AO<1.82及动脉导管彩色血流最细处宽度<0.29cm时,预示动脉导管多可以自然关闭。LA/AO>1.39,LVIDd/AO>1.97及动脉导管彩色血流最细处宽度>0.33cm时,预示动脉导管多无法自然关闭,选择合适时机进一步治疗是必要的。结论:足月产新生儿的早期超声心动图指标对预测动脉导管能否自然关闭是非常有价值的。     

胎儿动脉导管收缩及早闭的超声心动图诊断价值

目的研究与分析动脉导管收缩及早闭胎儿的超声心动图特征。 方法2016年1月至2018年2月于保定市第一中心医院接受产前及产后超声心动图检查和随访确诊的7例胎儿为动脉导管收缩,2例胎儿为动脉导管早闭,分析并总结9例胎儿异常超声心动图的表现及预后结果。 结果9例动脉导管收缩及早闭胎儿的主要超声表现：右心扩大、主肺动脉内径增宽,动脉导管收缩期及舒张期血流速度增加或无血流通过,三尖瓣反流等。9例超声心动图诊断动脉导管收缩及早闭的胎儿中1例于出生5 h后因呼吸衰竭死亡,其余8例均顺利产出;产后1周复查时3例胎儿超声心动图已正常;其余5例超声心动图均明显好转。 结论产前超声心动图检查可有效诊断出胎儿动脉导管收缩及早闭,当胎儿右心系统功能紊乱或接近衰竭且胎儿各器官基本成熟时,早期分娩对提高分娩质量,改善预后有较高的临床意义。     

动态监测极早产儿血25(OH)D水平及其对肺部疾病的影响

目的 动态监测极早产儿维生素D水平并探讨其对极早产儿肺部疾病的影响。方法 选取2019年6月-2020年12月期间于青岛大学附属医院新生儿重症监护室(neonatal intensive care unite, NICU)住院、并经得家长知情同意的胎龄<32周的极早产儿共126例,于生后24 h、1月、2月(或出院时)检测血清25-(OH)D水平。根据生后血清25-(OH)D水平,将极早产儿分为3组,维生素D缺乏组(n=71),25(OH)D<12 ng/ml;维生素D不足组(n=46),25(OH)D 12~<20 ng/ml;维生素D充足组(n =9),25(OH)D>20~≤100 ng/ml。所有早产儿在喂养耐受后给予维生素AD(其中维生素D 500 IU,维生素A 1500 IU)每日1粒,及维生素D3 400 IU;收集早产儿一般临床资料,比较各组间呼吸窘迫综合征(respiratory distress syndrome, RDS)、呼吸机使用时间、住院时间、早期肺高压、动脉导管未闭(patent ductus arteriosus, PDA)、支气管肺发育不良(bronchopulmonary dysplasia, BPD)发生情况。结果 (1)共纳入极早产儿126例,胎龄为26~31⁺⁶周,平均胎龄(29.75±1.52)周,其中男65例(51.59%),女61例(48.41%)。出生时维生素D缺乏组、不足组、充足组3组间的胎龄、出生体重、头围、身长等一般资料比较,差异均无统计学意义(P>0.05)。(2)出生时维生素D平均水平为(10.57±4.79) ng/ml,维生素D缺乏率达92.86%。每日口服维生素D900 IU,1月龄时(18.14±2.88) ng/ml,维生素缺乏率为72.3%,2月龄时(21.13±7.48) ng/ml,维生素D缺乏率为53.17%,无维生素D过量。(3)出生时维生素D缺乏组的RDS、BPD发生率明显升高,差异有统计学意义(P<0.05)。但出生时维生素D水平与BPD的严重程度无明显相关性(P=0.984)。不同维生素D水平组间Apgar评分、咖啡因使用时间、机械通气比率、无创通气时间、总用氧时间、PDA、住院时间及早期肺高压差异无统计学意义(P>0.05)。结论 (1)极早产儿普遍存在维生素D缺乏,补充维生素D 900 IU后,2月龄维生素D缺乏率仍然占53.17%,建议对早产儿进行个体化补充维生素D。(2)极早产儿出生时维生素D缺乏增加RDS、BPD的风险。     

Efficacy and renal tolerability of ibuprofen vs. indomethacin in preterm infants with patent ductus arteriosus

Indomethacin is commonly used for the treatment of patent ductus arteriosus (PDA) but has renal failure as a main side-effect. Ibuprofen seems to be efficient in closing the ductus with less side-effects, but few studies are available in literature as regards its use in preterm infants. This study is a retrospective analysis of clinical data in order to compare the efficacy and the renal tolerability of ibuprofen and indomethacin administered to preterm infants with gestational age (GA) < or = 30 weeks for the treatment of PDA. From our data, ibuprofen results pharmacologically as efficient as indomethacin and could be an alternative in prematures. About renal tolerability, our data confirm that non-steroidal anti-inflammatory drugs treatment could affect at least transiently renal function. Moreover, indomethacin could be more nephrotoxic compared with ibuprofen, as creatinine concentrations normalize more slowly in this group, although the mean difference between the two drugs was not significant as our population sample was small. Further studies are needed to assess whether ibuprofen is really less nephrotoxic than indomethacin, in particular by examining carefully the correlation between GA and ibuprofen administration.