Sheffield M J, Schmutz N, Lambert D K, Henry E, Christensen R D
Intermountain Healthcare, McKay-Dee Hospital Center, Ogden, UT, USA.
J Perinatol. 2009 Jan;29(1):39-43. doi: 10.1038/jp.2008.122. Epub 2008 Aug 28.
Ibuprofen might have advantages over indomethacin, when used to effectuate closure of a neonate's patent ductus arteriosus (PDA). Several previous studies indicate that platelet plug formation is impaired after administration of indomethacin, but it is not clear whether a similar impairment occurs following ibuprofen dosing.
We performed template bleeding times and PFA-100 tests (platelet function analyzer) on 20 neonates who had a PDA, before and again at various preset intervals following ibuprofen dosing.
Patients ranged from 23 to 40 weeks gestation and weighed 511 to 2566 g. Their first dose of ibuprofen was administered at 72 h (18 to 363 h) after birth (median, range). None of the subjects had clinical bleeding problems noted during the days they received ibuprofen dosing. The template bleeding times before dosing ranged from 135 to 450 s. Repeat tests were performed in groups of four, at 2 h, 4 to 6 h, 12 to 18 h, 24 h after the first dose, and at 2 h after the third dose of ibuprofen. No changes in bleeding times were detected. (P=0.299) A PFA-100 time was performed on all 20 patients before and again after the ibuprofen administration. However, 3 of the 40 tests were unsuccessful, because of microclots in the blood sample (n=1) or failure of the analyzer for an unspecified reason (n=2). Before the dosing the PFA-100 time ranged from 52 to 300 s. A paired t-test showed a slight but statistically significant lengthening in PFA-100 time after the ibuprofen administration (P=0.019). The correlation between the bleeding time and the PFA-100 was poor (R(2)=0.212, P=0.576).
On the basis of our present studies, we speculate that ibuprofen lysine administration to neonates with a PDA, when used according to the manufacturer's recommendations, has little adverse effect on platelet plug formation. This information might be a factor to consider when deciding whether to select indomethacin or ibuprofen for PDA closure.
在用于促使新生儿动脉导管未闭（PDA）闭合时，布洛芬可能比吲哚美辛更具优势。此前的多项研究表明，给予吲哚美辛后血小板栓形成受损，但尚不清楚布洛芬给药后是否会出现类似的损害。
我们对20例患有PDA的新生儿在布洛芬给药前及之后的不同预设间隔时间进行了模板出血时间和PFA - 100测试（血小板功能分析仪）。
患者的孕周为23至40周，体重为511至2566克。他们的首剂布洛芬在出生后72小时（18至363小时）（中位数，范围）给药。在接受布洛芬给药的日子里，没有受试者出现临床出血问题。给药前的模板出血时间为135至450秒。在首剂布洛芬后的2小时、4至6小时、12至18小时、24小时以及第三剂布洛芬后的2小时，以四人一组的方式进行重复测试。未检测到出血时间有变化。（P = 0.299）在布洛芬给药前后，对所有20例患者进行了PFA - 100时间检测。然而，40次检测中有3次未成功，原因是血样中有微凝块（n = 1）或分析仪因不明原因故障（n = 2）。给药前PFA - 100时间为52至300秒。配对t检验显示，布洛芬给药后PFA - 100时间略有延长，但具有统计学意义（P = 0.019）。出血时间与PFA - 100之间的相关性较差（R² = 0.212，P = 0.576）。
基于我们目前的研究，我们推测按照制造商的建议给患有PDA的新生儿使用赖氨酸布洛芬，对血小板栓形成几乎没有不良影响。在决定选择吲哚美辛还是布洛芬来闭合PDA时，这一信息可能是一个需要考虑的因素。
