喂养方案对吲哚美辛治疗动脉导管未闭早产儿效果及并发症的影响

Effect of feeding protocols on the efficacy and complications of indomethacin treatment for patent ductus arteriosus in preterm infants

摘要:

目的 探究喂养方案对吲哚美辛治疗动脉导管未闭（PDA）早产儿效果及并发症的影响。方法 选取2023年1月—2024年4月西南医科大学附属医院新生儿科收治的120例接受吲哚美辛治疗且胎龄< 37周的PDA患儿，根据随机数表法分为低奶量喂养组（60例）和高奶量喂养组（60例）。观察两组患儿治疗结束后PDA疗效、治疗前后肺动脉端内径变化、治疗期间不良反应发生率及病死率、治疗前后患儿血液和尿液中前列腺素E₂（PGE₂）变化。结果 低奶量喂养组与高奶量喂养组病死率比较，差异无统计学意义（P >0.05）。低奶量喂养组与高奶量喂养组第1个疗程、第2个疗程、2个疗程后累计的治疗效果比较，差异均无统计学意义（P >0.05）。两组患儿治疗前、治疗1个疗程、治疗2个疗程的肺动脉端内径比较，经重复测量设计的方差分析，结果 ①不同时间点的肺动脉端内径比较，差异有统计学意义（F =9.374，P <0.05）；②两组患儿肺动脉端内径比较，差异有统计学意义（F =9.851，P <0.05）；③两组患儿肺动脉端内径变化趋势比较，差异有统计学意义（F =9.139，P <0.05）。两组患儿治疗前、治疗1个疗程、治疗2个疗程的血液、尿液PGE₂水平比较，经重复测量设计的方差分析，结果 ①不同时间点的血液和尿液PGE₂水平比较，差异均有统计学意义（F =9.469和8.963，均P <0.05）；②两组患儿血液、尿液PGE₂水平比较，差异均有统计学意义（F =9.374和9.754，均P <0.05）；③两组患儿血液、尿液PGE₂水平变化趋势比较，差异均有统计学意义（F =10.181和9.276，均P <0.05）。高奶量喂养组总不良反应发生率高于低奶量喂养组（P <0.05）。结论 喂养方案不影响吲哚美辛治疗PDA早产儿效果，但低奶量喂养可降低患儿的不良反应发生率。

Abstract:

Objective To investigate the effects of feeding protocols on the efficacy and complications of indomethacin treatment for patent ductus arteriosus (PDA) in premature infants.Methods A total of 120 PDA premature infant with gestational age less than 37 weeks who were treated with indomethacin in the Department of Neonatology of the Affiliated Hospital of Southwest Medical University from January 2023 to April 2024 were selected. They were divided into the low-milk feeding group (60 cases) and high-milk feeding group (60 cases) according to the random number table method. The therapeutic effects for PDA after treatment, the changes of the pulmonary artery diameter before and after treatment, the incidence of adverse reactions and mortality during treatment, and the changes of prostaglandin E₂ (PGE₂) in blood and urine of children before and after treatment were observed.Results There was no statistically significant difference when comparing the mortality between the low-milk feeding group and the high-milk feeding group (P > 0.05). The cumulative treatment effects at the end of the first course, at the end of the second course and after the second course of treatments showed no difference between the two groups (P > 0.05). Comparison of pulmonary artery diameter before treatment, after one course of treatment and after two courses of treatment via repeated measures analysis of variance revealed that it was different among the time points (F = 9.374, P < 0.05) and between the groups (F = 9.851, P < 0.05), and that the change trend of pulmonary artery diameter was different between the two groups (F = 9.139, P < 0.05). Comparison of blood and urine levels of PGE₂ before treatment, after one course of treatment and after two courses of treatment via repeated measures analysis of variance demonstrated that they were different among the time points (F = 9.469 and 8.963, both P < 0.05) and between the two groups (F = 9.374 and 9.754, both P < 0.05), and that the change trends of them were different between the two groups (F = 10.181 and 9.276, both P < 0.05). The overall incidence of adverse reactions was higher in the high-milk feeding group than in the low-milk feeding group (P < 0.05).Conclusions Feeding protocols have no effect on the effectiveness of indomethacin in the treatment of preterm infants with PDA, but low-milk feeding could reduce the incidence of adverse reactions.