| 口服布洛芬治疗极低出生体质量儿动脉导管未闭及与脑出血相关性分析 |
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| 引用本文： | 瞿色华,彭万胜,尹淮祥,陈信. 口服布洛芬治疗极低出生体质量儿动脉导管未闭及与脑出血相关性分析[J]. 蚌埠医学院学报, 2021, 46(12): 1702-1706. DOI: 10.13898/j.cnki.issn.1000-2200.2021.12.015 |
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| 作者姓名： | 瞿色华 彭万胜 尹淮祥 陈信 |
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| 作者单位： | 蚌埠医学院第一附属医院 儿科, 安徽 蚌埠 233004 |
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| 基金项目： | 安徽省自然科学基金项目1908085MH299 |
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| 摘 要： | 目的研究口服布洛芬治疗极低出生体质量儿动脉导管未闭（PDA）及与脑出血的相关性。方法选取90例PDA极低出生体质量儿作为研究对象,根据治疗方案分为观察组和对照组,各45例,其中对照组口服吲哚美辛,观察组口服布洛芬。统计2组疗效、脑出血发生率及治疗前后心脏功能左心室射血分数（LVEF）、左心室舒张末期容量（LVEDV）、左心室收缩末期内径（LVESD）,脑血流动力学参数大脑前动脉（ACA）、中动脉（MCA）的舒张末期流速（Vd）、阻力指数（RI）;采用logistic分析PDA极低出生体质量儿脑出血发生风险。结果观察组治疗总有效率95.56%,与对照组91.11%比较差异无统计学意义（P>0.05）;治疗后2组LVEDV、LVESD、LVEF均低于治疗前（P < 0.05）,2组间比较差异无统计学意义（P>0.05）;治疗后观察组MCA、ACA的Vd高于对照组,RI低于对照组（P < 0.01）,观察组脑出血发生率低于对照组（P < 0.05）。logistic回归分析显示,胎龄长、出生体质量高、出生1 min Apgar评分高、布洛芬治疗是PDA极低出生体质量儿脑出血保护因素,呼吸暂停、宫内窘迫、机械通气、母亲大出血、滞产是PDA极低出生体质量儿脑出血危险因素（P < 0.05~P < 0.01）。结论口服布洛芬治疗PDA极低出生体质量儿效果确切,能改善心室重构,稳定脑血流,降低脑出血发生率。PDA极低出生体质量儿脑出血与呼吸暂停、宫内窘迫、机械通气等多种因素有关,应积极行颅脑超声检查并动态观察,以进一步减少脑损伤。
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| 关 键 词： | 动脉导管未闭 极低出生体质量儿 脑出血 布洛芬 脑血流动力学 阻力指数 |
| 收稿时间： | 2020-08-16 |
Oral ibuprofen for patent ductus arteriosus in very low birth weight infants and its correlation with cerebral hemorrhage |
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| Affiliation: | Department of Pediatrics, The First Affiliated Hospital of Bengbu Medical College, Bengbu Anhui 233004, China |
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| Abstract: | ObjectiveTo explore the relationship between oral ibuprofen in the treatment of patent ductus arteriosus(PDA) and cerebral hemorrhage in very low birth weight infants.MethodsNinety very low birth weight infants with PDA were selected as the research objects.According to the treatment plan, they were divided into study group and control group, with 45 cases in each group.Indomethacin was taken orally in the control group and ibuprofen was taken in the study group.The curative effect, incidence of cerebral hemorrhage and cardiac function[left ventricular ejection fraction(LVEF), left ventricular end diastolic volume(LVEDV), left ventricular end systolic diameter(LVESD)], cerebral hemodynamic parameters[end-diastolic flow velocity(Vd) and resistance index(RI) of the anterior cerebral artery(ACA) and the middle artery(MCA)] before and after treatment in the two groups were counted.Logistic analysis was used to analyze the risk of cerebral hemorrhage in very low birth weight infants with PDA.ResultsThe total effective rate of treatment in the study group was 95.56%, and there was no significant difference compared with 91.11% in the control group(P>0.05).After treatment, the levels of LVEDV, LVESD and LVEF in the two groups were lower than those before treatment(P < 0.05), but there was no significant difference between the two groups(P>0.05);after treatment, the Vd of MCA and ACA in the study group was higher than that in the control group, and the RI was lower than that in the control group(P < 0.01);the incidence of cerebral hemorrhage in the study group was lower than that in the control group(P < 0.05);logistic regression analysis showed that long gestational age, high birth weight, high Apgar score at 1 minute of birth, and ibuprofen treatment were protective factors for cerebral hemorrhage in very low birth weight infants with PDA.Apnea, intrauterine distress, mechanical ventilation, maternal hemorrhage, and delayed labor were risk factors for cerebral hemorrhage in very low birth weight infants with PDA(P < 0.05 to P < 0.01).ConclusionsOral ibuprofen is effective in the treatment of very low birth weight infants with PDA, which can improve ventricular remodeling, stabilize cerebral blood flow, and reduce the incidence of cerebral hemorrhage.In addition, cerebral hemorrhage in very low birth weight infants with PDA is related to various factors such as apnea, intrauterine distress, mechanical ventilation, etc., and craniocerebral ultrasound examination and dynamic observation should be actively performed to further reduce brain damage. |
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