布洛芬治疗早产儿动脉导管未闭失败的影响因素分析

目的：探究布洛芬治疗胎龄小于37周且出生体质量<1 500 g早产儿动脉导管未闭（PDA）失败的影响因素，寻找PDA布洛芬治疗失败的危险因素。方法：选取2017年1月30日至2019年3月30日于我院就诊的400例胎龄<37周且出生体质量<1 500 g的PDA早产儿，均接受布洛芬治疗和床旁心电图检查。根据动脉导管是否封闭分为动脉导管未封闭组和动脉导管封闭组，分析早产儿PDA治疗失败的影响因素。结果：400例PDA患儿在接受布洛芬治疗后，140例导管未封闭，治疗失败率为35.0%，导管封闭260例，封闭率为65.0%。动脉导管未封闭组胎龄小于动脉导管封闭组，出生体质量低于动脉导管封闭组，动脉导管两端压差、宫内窘迫、窒息史、合并感染、呼吸支持、新生儿临床危险指数评分、左心房与主动脉根部内径比高于动脉导管封闭组，首次治疗日龄大于动脉导管封闭组，差异有统计学意义（P<0.05）。多因素回归分析结果显示，出生体质量、呼吸窘迫综合征、新生儿临床危险指数评分、窒息史、动脉导管两端压差、呼吸支持、合并感染是布洛芬治疗PDA失败的独立影响因素。结论：出生体质量低、合并宫内窘迫、呼吸窘迫综合征、感染、动脉导管两端压差较大、呼吸支持、新生儿临床危险指数评分>5分是出生体质量小于1 500 g PDA早产儿布洛芬治疗失败的危险因素。

Factors Influencing the Failure of Ibuprofen in the Treatment of PDA in Premature Infants

Objective: To investigate thefactors influencing the failure of ibuprofen in the treatment of PDA in premature infantswith gestational age less than 37 weeks and birth weight less than 1,500 g, and to find the risk factors for ibuprofen treatment failure. Methods: A total of 400 PDA preterm infants with gestational age less than 37 weeks and birth weight less than 1,500 g were enrolled in our hospital from January 30, 2017 to March 30, 2019. All patients received ibuprofen and bedside electrocardiography before and after treatment. Treatment failure was defined as a bedside electrocardiogram indicating that the arterial catheter was not closed after 72 hours of treatment. The influencing factors of PDA treatment failure in premature infants were analyzed. Results: After ibuprofen treatment, arterial catheter was not closed in 140 patients and the failure rate of ibuprofen in the treatment of PDA was 35.0%, and 260 patients were successfully treated. The success rate was 65.0%. In arterial catheter not closed group, the gestational age was shorter than that of the arterial catheter closure group, the birth weight was lower than the arterial catheter closure group, the pressure difference between the two ends of the arterial catheter, intrauterine distress rate, asphyxia, infection, respiratory support rate, neonatal clinical risk index score, the ratio of the left atrium to the aortic root diameter were higher than those of the arterial catheter closure group, and the difference was statistically significant (P<0.05). Multivariate regression analysis showed that birth weight, respiratory distress syndrome, neonatal clinical risk index score, asphyxia history, arterial catheter pressure difference, respiratory support, and infection were independent factors influencing the failure of ibuprofen in the treatment of PDA. Conclusion: Low birth weight, combined intrauterine distress, respiratory distress syndrome, infection, large pressure difference between the two ends of the arterial catheter, respiratory support, neonatal clinical risk index score > 5 are risk factors in the ibuprofen treatment failed PDA premature infants with birth weight of less than 1500g.