| Objective:The ductus arteriosus (DA) is a fetal shunt that directs right ventricular outflow away from pulmonary circulation and into the descending aorta. In full term infants, functional closure of the DA may occur as early as10-15hours of age, anatomical closure of the DA may occur as three months old. A persistently patent ductus arteriosus (PDA) is one of the common congenital heart disease. The morbidity of PDA ranks No2in congenital heart malformation. Postnatal ductal closure is regulated by potassium channels, voltage-gated calcium channels, mitochondrial-derived reactive oxygen species, and endothelin1, depend on gestational age. Platelets ate tecruited to the luminal aspect of the DA during closure and probably promote thrombotic sealing of the constricted DA.The incidence of PDA in term infants has been estimated to be57per100000live births, whereas45%preterm infant with a birth weight(BW)<1750g can be expected to have a persistent PDA. HsPDA (PDA with significant left to right shunt) can increases morbidity and mortality of preterm infants. Furthermore, preterm infants who have been described to have a symptomatic PDA that ultimately leads to medical treatment. Neonatal respiratory distress syndrome was caused by the lack of lung surface active substance in preterm infants, the main treatment methods were auxiliary ventilator breathing and lung surface active material replacement therapy. During the convalescence of NRDS, because the blood flow of lungs increased in and pulmonary artery pressure droped, left to right shunt often occurred in the PDA. The purpose of this research was to evaluate the efficacy and safety of oral ibuprofen prophylacticly after therapy of pulmonary surfactant and mechanical ventilation in NRDS of preterm infants.Methods:44cases of NRDS premature babies of neonatal intensive care unit (NICU) in Linyi maternal and child health hospital were choosen between July2012and July2013. All of the cases were assigned into two groups after the treatment of mechanical ventilation and PS:the preventive group (n=21) were treated with ibuprofen prophylacticly, the control group (n=23) were treated with routine therapy. The rate of assisted ventilation time(nasal continuous positive airway pressure and mechanical ventilation), patent ductus arteriosus(PDA) incidence, feeding intolerance and grade Ⅲ-Ⅳ intraventricular hemorrhage were analyzed respectively. The adverse effects of ibuprofen and other complications during treatment were also been observed.Result:(1) The echocardiography was used to detect the PDA cases after the birth of7to10days in both groups. There were1cases (4.7%) of PDA in prevention group and12cases (52.2%) of PDA in control group respectively. There were significant difference between the two groups (P<0.01)(2) Assisted ventilation time was (72.0±11.5)h in prevention group and (96.2±12.1)h in control group, there were significant difference between the two groups(P<0.01).(3) The cases of grade Ⅲ-Ⅳ FVH were1case (4.76%) in prevention group an7cases(30.43%) in control groups, there were significant difference between the two groups (P<0.01).(4) The cases of NEC were1case in both groups, there were no difference between the two groups (P>0.05).(5) The incidence of oliguria, feeding intolerance and gastrointestinal bleeding had no statistical significance difference (P>0.05) between the two groups.Conclusions:After the application of mechanical ventilation and PS in the treatment of NRDS, the prophylactic use of ibuprofen can significantly reduce the morbidity of PDA and related complications in premature infants safely and effectively. |
