氢化可的松联合布洛芬治疗动脉导管未闭早产儿临床研究
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摘要
目的观察氢化可的松联合布洛芬治疗动脉导管未闭(PDA)早产儿的临床疗效。方法选取承德医学院附属医院2016年1月至2017年10月收治的PDA早产儿91例,按随机数字表法分为布洛芬组(A组,30例),氢化可的松组(B组,30例),氢化可的松联合布洛芬组(C组,31例)。结果 A组、B组、C组分别有25,23,29例患儿动脉导管关闭,3组比较差异无统计学意义(P> 0.05); 3组患儿治疗后血清前列腺素E_2(PGE_2)、脑钠肽(BNP)、内皮素-1(ET-1)水平,左心室收缩末前后径及容量和左心室舒张末前后径及容量均较治疗前降低,且C组均明显优于A组和B组(P <0.05); C组不良反应发生率明显低于A组和B组(P <0.05)。结论氢化可的松联合布洛芬可用于PDA早产儿的治疗,其机制与降低患儿血清PGE_2,BNP,ET-1水平及改善心功能有关。
Objective To observe the clinical effect of hydrocortisone combined with ibuprofen in the treatment of premature infants with patent ductus arteriosus(PDA).Methods Totally 91 premature infants with PDA admitted to the Affiliated Hospital of Chengde Medical University from January 2016 to October 2017 were selected and divided into ibuprofen group (group A,30 cases),hydrocortisone group(group B,30 cases),hydrocortisone combined with ibuprofen group(group C,31 cases) according to the random number table method.Results There were 25,23 and 29 infants with PDA closured in group A,group B and group C respectively,there was no significant difference among the three groups(P > 0.05).The levels of serum prostaglandin E_2(PGE_2),B-type natriuretic peptide(BNP),endothelin-1(ET-1),left ventricular end-systolic anteroposterior diameter and volume,and left ventricular end-diastolic diameter and volume in the three groups after treatment were lower than those before treatment,and those in group C were significantly better than those in group A and group B(P < 0.05).The incidence rate of adverse reactions in group C was significantly lower than that ingroup A and group B(P < 0.05).Conclusion Hydrocortisone combined with ibuprofen can be used in the treatment of premature infants with PDA.Its mechanism is related to the reduction of serum PGE_2,BNP,ET-1 levels and improvement of cardiac function.
Objective To observe the clinical effect of hydrocortisone combined with ibuprofen in the treatment of premature infants with patent ductus arteriosus(PDA).Methods Totally 91 premature infants with PDA admitted to the Affiliated Hospital of Chengde Medical University from January 2016 to October 2017 were selected and divided into ibuprofen group (group A,30 cases),hydrocortisone group(group B,30 cases),hydrocortisone combined with ibuprofen group(group C,31 cases) according to the random number table method.Results There were 25,23 and 29 infants with PDA closured in group A,group B and group C respectively,there was no significant difference among the three groups(P > 0.05).The levels of serum prostaglandin E_2(PGE_2),B-type natriuretic peptide(BNP),endothelin-1(ET-1),left ventricular end-systolic anteroposterior diameter and volume,and left ventricular end-diastolic diameter and volume in the three groups after treatment were lower than those before treatment,and those in group C were significantly better than those in group A and group B(P < 0.05).The incidence rate of adverse reactions in group C was significantly lower than that ingroup A and group B(P < 0.05).Conclusion Hydrocortisone combined with ibuprofen can be used in the treatment of premature infants with PDA.Its mechanism is related to the reduction of serum PGE_2,BNP,ET-1 levels and improvement of cardiac function.
引文
[1]SHEIKH AM,DUKE AK,SATTAR H.Transcatheter closure of Patent Ductus Arteriosus through only venous route[J].J Pak Med Assoc,2018,68(3):469-470.
[2]潘湘斌,欧阳文斌,李守军,等.单纯超声心动图引导下行动脉导管未闭封堵术的安全性和有效性[J].中华心血管病杂志,2015,43(1):31-33.
[3]李向农,江明宏,刘雪梅,等.超声心动图评估口服布洛芬治疗早产儿动脉导管未闭的疗效[J].中国循证心血管医学杂志,2016,8(3):361-363.
[4]张明衬,张改秀.青少年先天性肾上腺皮质增生症的研究进展[J].中国全科医学,2017,20(18):2289-2293.
[5]早产儿呼吸窘迫综合征流行病学调查协作组.产前糖皮质激素对早产小于胎龄儿病死率和主要并发症的影响[J].中华儿科杂志,2017,55(8):613-618.
[6]陆丹芳,刘云峰,童笑梅,等.早产儿动脉导管未闭的临床特点及其心脏血流动力学研究[J].中华儿科杂志,2015,53(3):187-193.
[7]潘雨晴,薛辛东.早产儿动脉导管未闭管理及其争议[J].中国实用儿科杂志,2015,30(2):85-88.
[8]杨波,高翔羽,黑明燕,等.对乙酰氨基酚治疗早产儿症状性动脉导管未闭的研究进展[J].中华实用儿科临床杂志,2017,32(2):152-155.
[9]陈涵强,欧阳夏,杨长仪,等.低血清皮质醇水平早产儿动脉导管未闭早期干预的相关性分析[J].中华新生儿科杂志,2017,32(6):420-425
[10]吴东平,朱璐卡.布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对患儿血浆和尿前列腺素E2水平的影响[J].实用药物与临床,2017,20(6):657-660.
[11]JEONG HA,SHIN J,KIM E,et al.Correlation of B-type natriuretic peptide levels and echocardiographic parameters in preterm infants with patent ductus arteriosus[J].Korean J Pediatr,2016,59(4):183-189.
[12]黄敏,封志纯,陈佳,等.早产儿动脉导管未闭与B型脑钠肽及氨基末端脑钠肽前体相关性[J].中华实用儿科临床杂志,2015,30(10):793-795.
[13]姚玮,高印生,王庆凯,等.阿托伐他汀对动脉导管未闭合并肺动脉高压介入术后影响[J].实用医学杂志,2016,32(22):3776-3778.
[14]SATPUTE MD,DONOHUE PK,VRICELLA L,et al.Cardiovascular instability after patent ductus arteriosus ligation in preterm infants:the role of hydrocortisone[J].J Perinatol,2012,32(9):685-689.
[15]LEE HY,KIM SH,JUNG KT,et al.Hydrocortisone for refractory hypotension of very low birth weight infant with patent ductus arteriosus:a case report[J].J Anesth,2012,26(1):134-135.
[2]潘湘斌,欧阳文斌,李守军,等.单纯超声心动图引导下行动脉导管未闭封堵术的安全性和有效性[J].中华心血管病杂志,2015,43(1):31-33.
[3]李向农,江明宏,刘雪梅,等.超声心动图评估口服布洛芬治疗早产儿动脉导管未闭的疗效[J].中国循证心血管医学杂志,2016,8(3):361-363.
[4]张明衬,张改秀.青少年先天性肾上腺皮质增生症的研究进展[J].中国全科医学,2017,20(18):2289-2293.
[5]早产儿呼吸窘迫综合征流行病学调查协作组.产前糖皮质激素对早产小于胎龄儿病死率和主要并发症的影响[J].中华儿科杂志,2017,55(8):613-618.
[6]陆丹芳,刘云峰,童笑梅,等.早产儿动脉导管未闭的临床特点及其心脏血流动力学研究[J].中华儿科杂志,2015,53(3):187-193.
[7]潘雨晴,薛辛东.早产儿动脉导管未闭管理及其争议[J].中国实用儿科杂志,2015,30(2):85-88.
[8]杨波,高翔羽,黑明燕,等.对乙酰氨基酚治疗早产儿症状性动脉导管未闭的研究进展[J].中华实用儿科临床杂志,2017,32(2):152-155.
[9]陈涵强,欧阳夏,杨长仪,等.低血清皮质醇水平早产儿动脉导管未闭早期干预的相关性分析[J].中华新生儿科杂志,2017,32(6):420-425
[10]吴东平,朱璐卡.布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭对患儿血浆和尿前列腺素E2水平的影响[J].实用药物与临床,2017,20(6):657-660.
[11]JEONG HA,SHIN J,KIM E,et al.Correlation of B-type natriuretic peptide levels and echocardiographic parameters in preterm infants with patent ductus arteriosus[J].Korean J Pediatr,2016,59(4):183-189.
[12]黄敏,封志纯,陈佳,等.早产儿动脉导管未闭与B型脑钠肽及氨基末端脑钠肽前体相关性[J].中华实用儿科临床杂志,2015,30(10):793-795.
[13]姚玮,高印生,王庆凯,等.阿托伐他汀对动脉导管未闭合并肺动脉高压介入术后影响[J].实用医学杂志,2016,32(22):3776-3778.
[14]SATPUTE MD,DONOHUE PK,VRICELLA L,et al.Cardiovascular instability after patent ductus arteriosus ligation in preterm infants:the role of hydrocortisone[J].J Perinatol,2012,32(9):685-689.
[15]LEE HY,KIM SH,JUNG KT,et al.Hydrocortisone for refractory hypotension of very low birth weight infant with patent ductus arteriosus:a case report[J].J Anesth,2012,26(1):134-135.