| Bankground1.overview of the PDA:The arterial catheter connected between the pulmonary artery and the aorta,is an important blood circulation pathway in the fetal period.Along with the first breath of the fetus,lung ventilation,increased blood flow to the lungs,etc.,the transformation of the fetal-neonatal blood circulation is completed,and the structure of the arterial catheter and the foramen ovale is no longer physiologically dependent.In most newborns,especially in term infants,functional closure of the arterial catheter is usually completed within 48 hours of birth.If the arterial catheter remains open 72 hours after birth,consider patent ductus arteriosus(PDA,pantent ductus arteriosus).According to epidemiological statistics,the prevalence of neonates with patent ductus arteriosus is up to 0.57%,and gestational age is negatively correlated with birth weight.Although the incidence is low,it can cause serious complications such as pulmonary hypertension and pulmonary edema,heart failure and cerebral hemorrhage.Therefore,patent ductus arteriosus is one of the important factors affecting the survival rate and prognosis of premature infants.At present,a large number of experimental data have been clinically proven that patent ductus arteriosus has a crucial impact on the long-term survival rate of newborns,especially premature infants,and the occurrence of related complications.It is generally believed that it should be active.Give clinical intervention.2.Incidence and treatment of patent ductus arteriosus in premature infants:Patent ductus arteriosus is one of the most common congenital heart diseases in newborns,especially premature infants,and the incidence is negatively correlated with gestational age and body weight.For preterm infants less than 32 weeks,the incidence rate is more than 80%,for low birth weight infants,the incidence is also higher,the body weight is less than 1000g(ultra-low birth weight infants)and super-mature children(less than 28 weeks gestational age)The opening of the catheter can last throughout the neonatal period.The use of only basic treatments such as controlling fluid intake and diuretics is not reliable.As early as 1985,indomethacin was used to treat PDA,but studies havegradually found that it has more adverse reactions,which may lead to complications such as renal insufficiency and cerebral hemorrhage.In recent years,as another cyclooxygenase inhibitor,ibuprofen has no significant difference in the efficacy of indomethacin in the treatment of patent ductus arteriosus,but the former has fewer adverse reactions than the latter.However,with the further understanding of patent ductus arteriosus,how to choose the timing of treatment is the key to achieving clinically precise treatment.3.Clinical application of pro-BNP:At present,pro-BNP has attracted attention as a laboratory indicator that is considered to be meaningful for the treatment and prediction of PDA.It mainly affects the regulation and secretion of ventricular muscle pressure and volume.Some scholars have confirmed its guiding significance in clinical practice.However,its exact efficacy is still inconclusive and needs further confirmation.Research object1.By comparing the early and delayed administration of oral ibuprofen in the treatment of patent ductus arteriosus,the difference in treatment effect between the two treatment time points was judged.2.To investigate whether there was any difference in the safety of oral ibuprofen at two time points by statistically delaying treatment,early treatment,and adverse reactions in the blank control group.3.Pro-BNP plays a role in predicting the development of PDA.Research methodWe selected prematures weighing less than 2000 g from September 2017 to December 2018 in our hospital.72-hour postoperative echocardiography was performed to identify 97 children with PDA.A prospective randomized double-blind controlled trial was designed.They were divided into three groups: delayed treatment,early treatment,and control.In the early treatment group,the first dose of ibuprofen was administered at a dose of 10 mg/kg 72 hours after birth,and then ibuprofen was administered again at 24 hours and 48 hours after administration.The delayed treatment group was again subjected to cardiac ultrasound 7 days after birth.There were still children with PDA who were treated with ibuprofen(same as before),and the control group did not receive this treatment.All patients were actively treated with primary disease and monitored for pro-BNP levels,liver and kidney function,blood routine and other complications.Research results1.There were no significant differences in basic data such as gestational age,birthweight,blood routine,DA diameter,pro-BNP level,etc.(P>0.05).2.The closure rate of the preventive treatment group and the delayed treatment group was significantly higher than that of the placebo group at 14 days after birth,and there was a significant difference(96.97%,93.10% vs 74.88%),while the preventive treatment group was delayed.The group closure rate increased,but there was no significant difference(96.97% vs 93.10,P>0.05).3.There were no statistically significant differences between the three groups during the observation period such as oliguria,NEC,and jaundice(P>0.05).4.The diameter of DA detected by PDA patients who spontaneously closed 7 days after birth was significantly smaller than that of children without spontaneous closure(1.79±0.26 VS 2.25±0.14,P<0.05).5.The pro-BNP value of children with spontaneous closure was also significantly lower than that of children with autism.The difference was significant(195.51±78.58 VS317.39±80.63,P<0.05).6.pro-BNP and DA studies of children with spontaneous closure and non-spontaneous closure at 7 days after birth found that there was a positive correlation between the two and a close relationship(?=0.793,P=0.00).Conclusion1,oral ibuprofen can improve the closure rate of the arterial catheter,and the adverse reactions did not increase significantly.2.The therapeutic effect of delayed oral ibuprofen is similar to that of early oral administration.3,plasma pro-BNP detection can be used as one of the indicators to evaluate the prognosis of PDA,its clinical value still needs more experimental data support... |
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