中华围产医学杂志
中華圍產醫學雜誌
중화위산의학잡지
CHINESE JOURNAL OF PERINATAL MEDICINE
2012年
8期
483-489
,共7页
杨长仪%陈涵强%杨文庆%任艳丽%石惠英
楊長儀%陳涵彊%楊文慶%任豔麗%石惠英
양장의%진함강%양문경%임염려%석혜영
动脉导管未闭%婴儿,早产%布洛芬%吲哚美辛
動脈導管未閉%嬰兒,早產%佈洛芬%吲哚美辛
동맥도관미폐%영인,조산%포락분%신타미신
Ductus arteriosus,patent%Infant,premature%Ibuprofen%Indomethacin
目的 比较口服布洛芬和吲哚美辛治疗早产儿动脉导管未闭(patent ductus arteriosus,PDA)的效果和安全性,并分析影响吲哚美辛治疗效果的因素. 方法 采用回顾性对照研究,2007年1月1日至2009年12月30日纳入的有临床症状的PDA早产儿160例为吲哚美辛组,2009年12月31日至2011年1月31日纳入的44例早产儿为布洛芬组.吲哚美辛组鼻饲吲哚美辛(25 mg/片),每次0.2 mg/kg,第2剂与第1剂间隔12h,第3剂与第2剂间隔24 h,3剂为1个疗程;布洛芬组口服布洛芬悬液(40 g/L),首剂10 mg/kg,第2、3剂均为5 mg/kg,每剂间隔24 h,3剂为1个疗程.采用卡方、两独立样本t检验和秩和检验比较2组导管的关闭情况及不良反应,用Logistic 回归模型分析影响吲哚美辛治疗效果的因素. 结果 (1)治疗效果比较:布洛芬组1个疗程动脉导管关闭率、2个疗程动脉导管关闭率和总关闭率分别为68.2％(30/44)、9.1％(4/44)和77.3％(34/44),与吲哚美辛组[63.8％(102/160)、6.9％(11/160)和70.6％ (113/160)]差异无统计学意义(x2分别为0.297、0.030和0.757,P均＞0.05).(2)不良反应:吲哚美辛组尿量＜1 ml/(kg?h)和血肌酐＞88μmol/L的发生率分别为21.3％(34/160)和26.9％(43/160),均高于布洛芬组[6.8％(3/44)和9.1％(4/44)],差异有统计学意义(x2分别为4.841和6.156,P均＜0.05).(3)影响吲哚美辛疗效的因素:胎龄小(OR=2.563,95％CI:1.099～5.976,P=0.029)、合并败血症(OR=4.575,95％CI:1.782～26.768,P=0.009)和新生儿呼吸窘迫综合征(OR=2.407,95％CI:1.023～5.664,P=0.044)是影响早产儿吲哚美辛治疗PDA疗效的危险因素,而母亲产前使用地塞米松(OR=0.530,95 ％CI:0.312～0.901,P=0.018)是保护因素. 结论 口服布洛芬与吲哚美辛治疗早产儿PDA疗效相当,但布洛芬对肾功能的影响较小,一些因素如败血症等影响吲哚美辛的疗效.
目的 比較口服佈洛芬和吲哚美辛治療早產兒動脈導管未閉(patent ductus arteriosus,PDA)的效果和安全性,併分析影響吲哚美辛治療效果的因素. 方法 採用迴顧性對照研究,2007年1月1日至2009年12月30日納入的有臨床癥狀的PDA早產兒160例為吲哚美辛組,2009年12月31日至2011年1月31日納入的44例早產兒為佈洛芬組.吲哚美辛組鼻飼吲哚美辛(25 mg/片),每次0.2 mg/kg,第2劑與第1劑間隔12h,第3劑與第2劑間隔24 h,3劑為1箇療程;佈洛芬組口服佈洛芬懸液(40 g/L),首劑10 mg/kg,第2、3劑均為5 mg/kg,每劑間隔24 h,3劑為1箇療程.採用卡方、兩獨立樣本t檢驗和秩和檢驗比較2組導管的關閉情況及不良反應,用Logistic 迴歸模型分析影響吲哚美辛治療效果的因素. 結果 (1)治療效果比較:佈洛芬組1箇療程動脈導管關閉率、2箇療程動脈導管關閉率和總關閉率分彆為68.2％(30/44)、9.1％(4/44)和77.3％(34/44),與吲哚美辛組[63.8％(102/160)、6.9％(11/160)和70.6％ (113/160)]差異無統計學意義(x2分彆為0.297、0.030和0.757,P均＞0.05).(2)不良反應:吲哚美辛組尿量＜1 ml/(kg?h)和血肌酐＞88μmol/L的髮生率分彆為21.3％(34/160)和26.9％(43/160),均高于佈洛芬組[6.8％(3/44)和9.1％(4/44)],差異有統計學意義(x2分彆為4.841和6.156,P均＜0.05).(3)影響吲哚美辛療效的因素:胎齡小(OR=2.563,95％CI:1.099～5.976,P=0.029)、閤併敗血癥(OR=4.575,95％CI:1.782～26.768,P=0.009)和新生兒呼吸窘迫綜閤徵(OR=2.407,95％CI:1.023～5.664,P=0.044)是影響早產兒吲哚美辛治療PDA療效的危險因素,而母親產前使用地塞米鬆(OR=0.530,95 ％CI:0.312～0.901,P=0.018)是保護因素. 結論 口服佈洛芬與吲哚美辛治療早產兒PDA療效相噹,但佈洛芬對腎功能的影響較小,一些因素如敗血癥等影響吲哚美辛的療效.
목적 비교구복포락분화신타미신치료조산인동맥도관미폐(patent ductus arteriosus,PDA)적효과화안전성,병분석영향신타미신치료효과적인소. 방법 채용회고성대조연구,2007년1월1일지2009년12월30일납입적유림상증상적PDA조산인160례위신타미신조,2009년12월31일지2011년1월31일납입적44례조산인위포락분조.신타미신조비사신타미신(25 mg/편),매차0.2 mg/kg,제2제여제1제간격12h,제3제여제2제간격24 h,3제위1개료정;포락분조구복포락분현액(40 g/L),수제10 mg/kg,제2、3제균위5 mg/kg,매제간격24 h,3제위1개료정.채용잡방、량독립양본t검험화질화검험비교2조도관적관폐정황급불량반응,용Logistic 회귀모형분석영향신타미신치료효과적인소. 결과 (1)치료효과비교:포락분조1개료정동맥도관관폐솔、2개료정동맥도관관폐솔화총관폐솔분별위68.2％(30/44)、9.1％(4/44)화77.3％(34/44),여신타미신조[63.8％(102/160)、6.9％(11/160)화70.6％ (113/160)]차이무통계학의의(x2분별위0.297、0.030화0.757,P균＞0.05).(2)불량반응:신타미신조뇨량＜1 ml/(kg?h)화혈기항＞88μmol/L적발생솔분별위21.3％(34/160)화26.9％(43/160),균고우포락분조[6.8％(3/44)화9.1％(4/44)],차이유통계학의의(x2분별위4.841화6.156,P균＜0.05).(3)영향신타미신료효적인소:태령소(OR=2.563,95％CI:1.099～5.976,P=0.029)、합병패혈증(OR=4.575,95％CI:1.782～26.768,P=0.009)화신생인호흡군박종합정(OR=2.407,95％CI:1.023～5.664,P=0.044)시영향조산인신타미신치료PDA료효적위험인소,이모친산전사용지새미송(OR=0.530,95 ％CI:0.312～0.901,P=0.018)시보호인소. 결론 구복포락분여신타미신치료조산인PDA료효상당,단포락분대신공능적영향교소,일사인소여패혈증등영향신타미신적료효.
Objective To compare the efficacy and safety of oral ibuprofen and indomethacin for the closure of patent ductus arteriosus (PDA) in preterm infants and investigate the factors affecting the effect of indomethacin.Methods Two hundred and four preterm infants with symptomatic PDA were enrolled in this retrospective study.They were divided into two groups accroding to the admission date.From Jan.1,2007 to Dec.30,2009,44 infants orally administered ibuprofen (one course:first dose was 10 mg/kg,followed by two doses of 5 mg/kg at 24 h intervals) were as ibuprofen group.From Dec.31,2009 to Jan.31,2011,160 infants orally administered indomethacin (one course:0.2 mg/kg,at 12 h and 24 h intervals for three times) were as indomethacin group.Chisquare test,t test and rank sum test were used to compare the rate of ductal closure,side effects and complications of two groups.Influence factors of indomethacin therapy were analyzed with Logistic regression.Results There were no differences of overall ductal closure rate [77.3％ (34/44) vs 70.6％ (113/160),x2 =0.757,P＞0.05],one course therapy [68.2％ (30/44) vs 63.8％(102/160),x2=0.297,P＞0.05] and two courses therapy closure rate [9.1％ (4/44) vs 6.9％(11/160),x2 =0.030,P＞0.05] between i buprofen group and indomethacin group.The incidences of oliguria [＜1 ml/(kg ? h)] and high serum creatinine (＞88 μmol/L) of indomethacin group were higher than those in ibuprofen group [21.3％ (34/160) vs 6.8％ (3/44),x2=4.841,P=0.028;26.9％ (43/160) vs 9.1％ (4/44),x2=6.156,P=0.013].Logistic regression analysis showed that small gestational age (OR=2.563,95％CI:1.099-5.976,P=0.029),neonatal respiratory distress syndrome (OR=2.407,95％CI:1.023-5.664,P=0.044)and septicemia (OR=4.575,95％CI:1.782-26.768,P=0.009) were unfavorable factors for ductal closure in preterm infants underwent indomcthacin therapy,while antenatal steroid (OR=0.530,95％CI:0.312-0.901,P=0.018) was a favorable factor.Conclusions Oral ibuprofen have the same effects as indomethacin on PDA treatment in preterm infants,but with fewer side effects on renal function in terms of urine output and serum creatinine level.Some factors such as septicemia may affect the theraputic effects.
