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目的探讨布洛芬混悬液联合醋酸氢化可的松片治疗早产儿动脉导管未闭的临床疗效。方法选取2013年8月—2016年8月天津市蓟州区人民医院儿科收治的动脉导管未闭早产儿134例作为研究对象,依据患者治疗方式不同分为布洛芬组(44例)、氢化可的松组(44例)和联合组(46例)。布洛芬组口服布洛芬混悬液,首次剂量10 mg/kg,第2、3剂量5 mg/kg,每次间隔24 h,共3次。氢化可的松组口服醋酸氢化可的松片,1片/次,1次/d,治疗3 d。联合组给予布洛芬混悬液和醋酸氢化可的松片治疗,方法同上。观察3组的临床疗效,比较3组的前列腺素E2(PGE2)、N末端B型脑钠肽(NT-pro BNP)、内皮素-1(EF-1)和心功能指标。结果治疗后,布洛芬组、氢化可的松组和联合治疗组动脉导管未闭关闭率分别为84.09%、79.55%、93.48%,联合治疗组动脉导管未闭关闭率高于布洛芬组和氢化可的松组,3组比较差异有统计学意义(P<0.05)。治疗后,3组血浆PGE2、尿PGE2、NT-pro BNP和EF-1水平均明显下降,同组治疗前后比较差异具有统计学意义(P<0.05);且联合组这些观察指标明显低于布洛芬组和氢化可的松组,差异具有统计学意义(P<0.05)。治疗后,3组左心室收缩末前后径(LVESD)、左心室舒张末前后径(LVEDD)、左心室收缩末容量(LVESV)和左心室舒张末容量(LVEDV)均明显下降,同组治疗前后比较差异有统计学意义(P<0.05);且联合组这些观察指标明显低于布洛芬组和氢化可的松组,差异具有统计学意义(P<0.05)。联合组高胆红素血症、消化道出血发生率均低于布洛芬组和氢化可的松组,3组比较差异具有统计学意义(P<0.05)。结论布洛芬混悬液联合醋酸氢化可的松片治疗早产儿动脉导管未闭具有较好的临床疗效,降低了患儿PGE_2、NT-pro BNP、EF-1水平,改善患儿心功能指标,安全性较好,具有一定的临床推广应用价值。
Objective To investigate the clinical efficacy of ibuprofen suspension combined with hydrocortisone acetate in the treatment of patent ductus arteriosus in preterm infants. Methods Totally 134 preterm infants with patent ductus arteriosus were treated in pediatric department of Jizhouzhou People’s Hospital of Tianjin from August 2013 to August 2016. The patients were divided into ibuprofen group (n = 44), hydrogenation Cortisone group (n = 44) and combination group (n = 46). Ibuprofen group oral ibuprofen suspension, the first dose of 10 mg / kg, the second dose of 5 mg / kg, each interval of 24 h, a total of 3 times. Hydrocortisone group oral hydrocortisone acetate tablets, 1 / time, 1 / d, the treatment of 3 d. The combination group was treated with ibuprofen suspension and hydrocortisone acetate tablets as above. The clinical effects of the three groups were observed. The prostaglandin E2 (PGE2), N-terminal pro-brain natriuretic peptide (BNP), endothelin-1 (EF-1) and cardiac function were compared between the three groups. Results After treatment, the closure rates of patent ductus arteriosus in ibuprofen group, hydrocortisone group and combination group were 84.09%, 79.55% and 93.48% respectively. The closure rate of patent ductus arteriosus in combination group was higher than that in ibuprofen group And hydrocortisone group, the difference between the three groups was statistically significant (P <0.05). After treatment, the plasma PGE2, urinary PGE2, NT-pro BNP and EF-1 levels were significantly decreased in the three groups (P <0.05), and the observation group was significantly lower than the control group The differences were statistically significant (P <0.05) between the two groups. After treatment, LVESD, LVEDD, LVESV and LVEDV were significantly decreased in both groups before and after treatment (P <0.05). The observation indexes in the combined group were significantly lower than those in the ibuprofen and hydrocortisone groups (P <0.05). The incidence of hyperbilirubinemia and gastrointestinal bleeding in the combination group was lower than that in the ibuprofen group and hydrocortisone group. The differences between the three groups were statistically significant (P <0.05). Conclusion ibuprofen suspension combined with hydrocortisone acetate tablets in the treatment of patent ductus arteriosus in preterm infants has better clinical curative effect, reduces the levels of PGE_2, NT-pro BNP and EF-1 in children, and improves the cardiac function indexes , Safety is better, with a certain clinical application value.