静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭疗效比较

目的　探讨静脉注射和口服吲哚美辛治疗早产儿动脉导管未闭 (PDA)的疗效。方法　经心脏彩超确诊的有症状PDA早产儿 4 9例 ,按给药剂型及途径分为静注组 (2 1例 )和口服组 (2 8例 )。剂量及给药间隔时间相同。比较两组PDA关闭率和不良反应。结果　两组单纯PDA闭合、并其他疾病PDA闭合均无显著差异。静注组立即闭合率明显高于口服组 (P <0 .0 5 )。两组较快闭合、迟缓闭合和总闭合虽有差别 ,但无统计学意义。静注组胃肠出血、肾功能减低及高胆红素血症与口服组比较均无显著差异。静注组不良反应总人次明显低于口服组 (P <0 .0 5 )。结论　一定剂量范围内静脉注射或口服吲哚美辛治疗早产儿PDA均具一定有效性和安全性 ,但口服给药不良反应相对较多     

消炎痛治疗足月儿动脉导管未闭1例

一足月儿生后两天经彩色多普勒超声心动图证实动脉导管未闭后 ,口服消炎痛三剂 ,第九天再作彩超动脉导管已闭。动脉导管未闭是小儿时期常见的先天性心脏病 ,其发生率约占先天性心血管畸形的2 0 %左右 ,女性多于男性 ,约 2～ 3:1。患儿男 ,2天 ,足月顺产 ,出生体重380 0ｇ ,生后查体心脏异常 ,故门诊就诊。体检 :患儿一般情况可 ,面色红润 ,无紫绀 ,呼吸平稳 ,胸骨左沿 2、3肋间可闻及收缩期吹风样杂音 ,两肺呼吸音清 ,腹平软。彩超显示 :心脏大小及搏动未见异常 ,主动脉短轴主肺动脉长轴切面见降主动脉与主肺动脉间无回声通道相连 ,内径 4ｍ…     

消炎痛治疗足月新生儿动脉导管未闭疗效及安全性评价

目的 探讨口服消炎痛治疗足月新生儿动脉导管未闭(PDA)的疗效及安全性.方法 对经彩色多普勒超声心动图确诊的足月新生儿动脉导管未闭34例分为治疗组和对照组,治疗组23例给予服消炎痛治疗,每次0.2 mg/kg,鼻饲给药,每24小时1次,共用3次为一疗程,全部病例均仅用一疗程.未加用消炎痛治疗的11例作为对照组.比较两组动脉导管的关闭率;治疗组用药前后监测肾功能、血生化及血小板变化,观察记录尿量、胃肠道症状及出血情况等.结果 治疗组23例,动脉导管关闭17例,关闭率73.91%.对照组11例,关闭5例,关闭率45.45%,两组比较,治疗组PDA闭合率明显高于对照组,差异有显著性意义(P＜0.05).治疗组中除2例发生一过性少尿外,未发生其他不良反应.结论 消炎痛治疗足月新生儿PDA安全有效.     

口服布洛芬治疗早产儿动脉导管未闭的疗效

目的观察口服布洛芬治疗早产儿动脉导管未闭(PDA)的疗效及安全性。方法发生症状性PDA的早产儿22例,出生体质量(1426.59±355.74)g,胎龄(29.95±2.53)周。用口服布洛芬混悬滴剂治疗,布洛芬10 mg/kg,共3次,间隔24 h。用药期间监测心率、血压、氧饱和度、血糖、尿量、胆红素、电解质。治疗结束后复查肾功能、血常规、超声心动图、头颅B超。结果经治疗14例(63.63%)PDA关闭,疗效与出生体质量有关,出生体质量≥1500 g疗效好于出生体质量<1500 g(P<0.05)。3例(13.64%)在PDA关闭后发生再开放。13例(59.10%)患儿用药后出现一过性少尿[尿量<1 mL/(kg.h)],均发生于第1次给药后;治疗前肌酐和尿素水平与治疗后比较无显著性差异(P>0.05)。血小板治疗前后比较无显著性差异(P>0.05)。10例(45.56%)发生喂养不耐受,经减少喂养量或暂停喂养后均好转。结论口服布洛芬治疗早产儿PDA有一定疗效,且安全,使用方便,但尚需进行早产儿药代动力学研究及临床对照研究以明确其疗效,制定有效治疗方案。     

口服消炎痛治疗新生儿动脉导管未闭临床观察

为观察消炎痛关闭新生儿(足月儿及早产儿)动肪导管未闭(PDA)的效果,对经心脏彩超确诊的新生儿PDA90例,其中72例(足月儿33例,早产儿39例)口服消炎痛治疗,另18例未用消炎痛作为对照组.结果显示,消炎痛治疗组动脉导管关闭率明显高于对照组;其中早产儿关闭率(92.37%)高于足月儿(78.78%),并明显高于对照组(92.37%比42.8%);足月儿用药组与对照组相比无明显差异.消炎痛治疗组中有21例合并其他先心病,结果单纯PDA导管关闭率(94.12%)明显高于合并其他先心痛的PDA组(61.9%).早产儿动脉导管的自闭率低于足月儿.结论口服消炎痛治疗早产儿PDA的效果优于足月儿,单纯PDA优于合并其他先心病者,足月儿在治疗原发病后PDA自闭的可能性大,早产儿自闭的可能性相对较小.     

布洛芬口服治疗动脉导管未闭早产儿的疗效及安全性

目的观察布洛芬治疗动脉导管未闭(PDA)早产儿的疗效及安全性。方法早产儿PDA 43例,根据有无并其他心脏畸形,分为单纯PDA组及复合型PDA组,单纯PDA组根据出生体质量分为≥1500 g及<1500 g组。均予以布洛芬口服治疗,观察布洛芬的疗效及其不良反应。结果单纯组PDA关闭率为80.78%,复合组关闭率为47.06%,两组有显著差异(χ2=5.981 P<0.01);体质量≥1500 g组关闭率为80.0%,<1500 g组关闭率为81.81%,两组无显著差异(χ2=0.38 P>0.05)。43例仅1例出现胃潴留,未观察到其他不良反应。结论布洛芬口服治疗早产儿单纯PDA疗效好,对复合型PDA也有一定效果。     

早产儿动脉导管未闭管理及其争议

动脉导管未闭(PDA)是早产儿的特殊生理状态,其自发关闭率较高,但持续PDA开放,不仅导致一系列的并发症,还可增加患儿的死亡率。环氧化酶抑制剂吲哚美辛和布洛芬,其关闭PDA的疗效已被公认,但也引起心、脑、肾、肠的血流减少,布洛芬对器官血流的影响更小,特别是能降低坏死性小肠结肠炎(NEC)和一过性肾功能不全的发生率。手术结扎是目前关闭PDA的最确实方法,但仍存在发生单侧声带麻痹、气胸、乳糜胸及脊柱侧弯等并发症的潜在风险。     

口服美林对早产儿动脉导管未闭的疗效观察

目的　口服美林与消炎痛对早产儿动脉导管未闭 (PDA)的疗效和副作用进行对比分析 ,以便寻找更好的治疗方法。方法　将 35例早产儿PDA患儿随机分为 2组 :A组 17例给予口服美林治疗 ,B组 18例口服消炎痛治疗。结果　美林 16例PDA(94 1% )闭合 ,消炎痛组 10例 (6 1 1% )闭合 ,美林组PDA闭合率明显高于消炎痛组 (P <0 0 2 5 )。在副作用方面 ,美林组仅 1例 (5 9% )有少量胃出血 ,而消炎痛组 10例 (5 5 6 % )分别并发了坏死性小肠结肠炎 (2例 ) ,胃出血(2例 ) ,IVH 1例 ,肾功能损害 (4例 ) ,低血糖、低钠血症 (1例 ) ;明显高于美林组 (P <0 0 0 5 )。结论　口服美林治疗早产儿PDA不仅疗效优于消炎痛 ,而且副作用少 ,安全系数高     

小儿复杂动脉导管未闭的外科治疗

复杂动脉导管未闭是指合并其他先天性心脏、血管畸形的动脉导管未闭（PDA）,约占PDA总数的7%～12%。本院1995年5月至2007年10月共手术治疗复杂PDA患儿37例,包括非生命依赖型35例和生命依赖型2例,体外循环下一期封闭动脉导管并矫正并发的心血管畸形30例,分期治疗7例（先非体外循环下结扎动脉导管,1个月内体外循环下矫正心内畸形）,疗效满意。     

Usefulness of Indomethacin for Patent Ductus Arteriosus in Full-Term Infants

The aim of this retrospective study was to evaluate the effectiveness of indomethacin therapy for patent ductus arteriosus (PDA) in full-term infants. The patients were 41 full-term infants with a PDA birth weight (BW) > or =2500 g and a gestational age (GA) > or =37 weeks. The echocardiographic evaluation and medical management of PDA in these infants was similar to that for PDA in low-birth-weight infants. Indomethacin (0.2-0.25 mg/kg/dose) was given intravenously at 12-24-hour intervals within 23 days of birth. Of the 41 infants, 12 showed complete closure, and 13 showed improvement of clinical symptoms. These 25 infants were classified as the responder group (61%). The other 16 infants, who did not show improvement in clinical symptoms, were classified as the nonresponder group. Statistical analysis revealed no difference between the two groups regarding GA, BW, Apgar score at 1 minute, minimum diameter of the DA before treatment, the average age at the initiation of treatment, and DA flow pattern. No severe adverse reactions were observed in any infant. Indomethacin therapy appears to be an effective medical treatment option for PDA in full-term symptomatic infants prior to considering surgical treatment.     

High-Dose Oral Ibuprofen in Treatment of Patent Ductus Arteriosus in Full-Term Neonates

Background:

Patent ductus arteriosus (PDA) is an important risk for heart failure due to left to right shunt in term neonates.

Objectives:

In this study, we evaluated the effect of high dose ibuprofen in closure of PDA in term neonates.

Patients and Methods:

We used double dose ibuprofen (20 mg/kg, 10 mg/kg, and 10 mg/kg) for 3 - 30 day old term neonates with PDA who were admitted in the neonatal wards of Shiraz University of Medical Sciences. The results of this study were compared to the data of the previous study in our center which used the low dose of ibuprofen (10 mg/kg, 5 mg/kg, and 5 mg/kg).

Results:

29 full term neonates received high-dose ibuprofen, in 18 neonates, PDA was closed after 4 days (62.1% versus 43.3% for the standard dose and 4.7% for the control group in the previous study) (P = 0.001). The results showed no significant correlation between the closure rate and gestational age, postnatal age, sex, and weight. In the 4^th day of treatment, size of the pulmonic end of ductus arteriosus decreased from 2.09 mm to 0.77 mm compared to 1.68 mm to 0.81 mm in the standard dose of oral ibuprofen and 2.1 mm to 1.4 mm in the control group (P = 0.046).

Conclusions:

This study indicated that high-dose oral ibuprofen was more effective in closing or decreasing the size of PDA.     

Comparison of Oral Ibuprofen and Intravenous Indomethacin for the Treatment of Patent Ductus Arteriosus in Extremely Low Birth Weight Infants

ObjectiveThere are few published reports concerning the efficacy of oral ibuprofen for the treatment of patent ductus arteriosus (PDA) in extremely low birth weight (ELBW) infants. Oral ibuprofen was compared to intravenous indomethacin regarding efficacy and safety in the treatment of PDA in infants weighting less than 1,000 g at birth.MethodThis was a retrospective study in a single center. Data on ELBW infants who had an echocardiographically confirmed PDA were collected. The infants were treated with either intravenous indomethacin or oral ibuprofen. Rate of ductal closure, need for additional treatment, drug-related side effects or complications, and mortality were compared between the two treatment groups.Result26 infants who received indomethacin and 22 infants who received ibuprofen were studied. The overall rate of ductal closure was similar between the two treatments: it occurred in 23 of 26 infants (88.5%) treated with indomethacin, and in 18 of 22 infants (81.8%) treated with ibuprofen (p = 0.40). The rate of surgical ligation (11.5% versus 18.2%; p = 0.40) did not differ significantly between the two treatment groups. No significant difference was found in post-treatment serum creatinine concentrations between the two groups. There were no significant differences regarding additional side effects or complications.ConclusionIn ELBW infants, oral ibuprofen is as efficacious as intravenous indomethacin for the treatment of PDA. There were no differences between the two drugs with respect to safety. Oral ibuprofen could be used as an alternative agent for the treatment of PDA in ELBW infants.     

早产儿动脉导管未闭的临床研究

目的　观察早产儿动脉导管未闭 (PDA)发生率、影响因素及血流动力学的变化 ,提供监测及干预治疗的建议。方法　 86例胎龄 2 8～ 3 6周、无呼吸机治疗 (未用或已停用 )的早产儿 ,出生 2～ 5d行首次超声心动图检查。对诊断为PDA的早产儿动态超声心动图监测。结果　生后 3～ 4d超声心动图诊断PDA 2 2例 ,胎龄 (3 3 .1± 2 .0 )周。生后 8.5d 2 0例复查 ,16例动脉导管自行关闭 ;4例PDA早产儿经治疗 ,动脉导管关闭 2例 (1例吲哚美辛 ;1例动脉导管再开放 )。最终遗留PDA 3例。单因素及多因素Logistic回归分析发现 ,出生体质量越低 ,PDA发生机率越高 (χ2 =2 .890 7　P =0 .0 891) ;生后窒息及严重疾病增加PDA发生的危险性 (χ2 =4.3 72 9　P =0 .0 3 65 ;χ2 =11.65 90　P =0 .0 0 0 6)。PDA存在使早产儿左心房 /主动脉根内径比值增高 (1.0 8± 0 .18vs 1.0 0± 0 .0 7　P =0 .0 48) ,心功能良好。结论　平均胎龄 3 3周、平均日龄 3d、一般状况较好的早产儿超声心动图诊断PDA机率 2 5 .6% ,85 %早产儿PDA可自行关闭。低出生体质量、出生窒息、严重疾病及症状性PDA发生或持续均是高危因素。     

布洛芬治疗早产儿动脉导管未闭效果及影响因素

目的探讨口服布洛芬治疗早产儿动脉导管未闭（PDA）的疗效及其相关因素对治疗效果影响。方法选取发生症状性PDA早产儿42例,予口服或鼻饲布洛芬混悬滴剂,共3次,首剂10mg/kg,于24、48h后各予5mg/kg。观察内容包括每一疗程布洛芬治疗的效果和总布洛芬治疗的最终效果。记录相关因素包括性别、体质量、日龄、婴儿的宫内发育状况、治疗前动脉导管内径、首剂布洛芬应用时的日龄（h）及不良反应等。结果本组早产儿经布洛芬1个疗程治疗,PDA的关闭率为78.5%。经过2个疗程治疗后,最终关闭PDA的总有效率为85.7%。患儿出生体质量和首次布洛芬应用时间对PDA的关闭效果有显著影响（P〈0.05）。而孕周、婴儿性别、应用布洛芬前PDA内径和胎儿的宫内发育状况,对布洛芬的使用效果无影响（P〉0.05）。结论布洛芬对关闭早产儿PDA有良好效果,且较安全,其效果随着早产儿出生体质量增加而增强,首剂布洛芬应用时间越早,其PDA关闭率越高。