目的探讨口服布洛芬与对乙酰氨基酚治疗早产儿症状性动脉导管未闭(sPDA)时血浆和尿前列腺素E_2(PGE_2)水平的变化。方法选择2012年10月至2015年6月徐州医学院徐州临床学院儿科新生儿病房收治的生后15 h~10天诊断sPDA的早产儿,随机分为布洛芬组和对乙酰氨基酚组。布洛芬组口服布洛芬10 mg/kg,24 h及48 h后再各给予5 mg/kg;对乙酰氨基酚组口服对乙酰氨基酚每次15 mg/kg,每6 h一次,共3天。首剂给药后72 h复查超声心动图,并检测治疗前后血浆和尿PGE_2水平,观察患儿尿量及并发症发生情况,分析血浆和尿PGE_2水平相关性。应用SPSS 20.0统计软件,分别采用卡方检验、t检验、非参数检验之Mann-Whitney U法、Pearson相关分析。结果布洛芬组43例,对乙酰氨基酚组44例。两组治疗后血浆和尿PGE_2水平均明显低于治疗前[布洛芬组血浆:(47.3±24.7)比(70.0±35.7)ng/L,对乙酰氨基酚组血浆:(59.9±32.9)比(74.2±35.5)ng/L,布洛芬组尿:(115.4±46.3)比(189.0±62.4)ng/L,对乙酰氨基酚组尿:(139.3±54.0)比(184.4±73.8)ng/L,P<0.05];对乙酰氨基酚组治疗后血浆和尿PGE_2水平下降幅度[12.6(5.7,19.5)ng/L、(45.0±36.9)ng/L]明显小于布洛芬组[18.5(10.1,33.8)ng/L、(73.5±44.8)ng/L,P=0.031、0.002]。对乙酰氨基酚组动脉导管闭合率与布洛芬组差异无统计学意义(70.5%比76.7%,P=0.506);虽然对乙酰氨基酚组少尿发生率明显低于布洛芬组(2.3%比14.0%),但差异无统计学意义(P=0.108)。两组治疗后大便隐血阳性率、脑室内出血、新生儿坏死性小肠结肠炎、支气管肺发育不良发生率差异无统计学意义(P>0.05)。两组治疗后血小板、血肌酐、谷丙转氨酶均无明显变化(P>0.05)。成功组与失败组治疗后血浆和尿PGE_2水平下降幅度差异无统计学意义(P>0.05),少尿组治疗后血浆和尿PGE_2水平下降幅度[35.0(26.3,49.8)ng/L、(135.0±38.0)ng/L]明显大于非少尿组[13.3(6.7,20.8)ng/L、(52.5±37.0)ng/L,P=0.001、<0.001]。血浆和尿PGE_2水平高度正相关(r=0.648,P<0.001),尿PGE_2变异系数0.427小于血浆PGE_2的0.539。结论口服对乙酰氨基酚治疗早产儿sPDA的疗效与布洛芬相似,不良反应较少。对乙酰氨基酚使PGE_2水平下降幅度小于布洛芬,少尿发生率可能也低于布洛芬。尿PGE_2水平比血浆PGE_2水平更适合临床应用。 Objective To investigate the changes of plasma and urinary prostaglandin E_2 (PGE_2) level in patients with symptomatic patent ductus arteriosus (sPDA) treated with oral ibuprofen and acetaminophen. Methods From October 2012 to June 2015, premature neonates with sPDA diagnosed 15 days to 10 days after pediatric neonatal ward of Xuzhou Medical College from Xuzhou Medical College were randomly divided into ibuprofen group and acetaminophen group. Ibuprofen group oral ibuprofen 10 mg / kg, 24 h and 48 h after each given 5 mg / kg; acetaminophen group paracetamol oral 15 mg / kg, once every 6 h, a total of 3 days. Echocardiography was performed 72 hours after the first dose, and plasma and urinary PGE 2 levels were measured before and after treatment. Urine volume and complications were observed in children. The correlation between plasma and urinary PGE 2 levels was analyzed. Using SPSS 20.0 statistical software, respectively, using the chi-square test, t test, non-parametric test Mann-Whitney U method, Pearson correlation analysis. Results Ibuprofen group 43 cases, acetaminophen group 44 cases. Plasma and urinary PGE 2 levels in both groups after treatment were significantly lower than before treatment [ibuprofen plasma: (47.3 ± 24.7) vs (70.0 ± 35.7) ng / L, acetaminophen plasma: (59.9 ± 32.9) vs (74.2 ± 35.5) ng / L in the ibuprofen group, (115.4 ± 46.3) vs 189.0 ± 62.4 ng / L in the ibuprofen group, and (139.3 ± 54.0) vs 184.4 ± 73.8 ng / L, P <0.05]. The decrease of PGE 2 level in plasma and urine after acetaminophen treatment was significantly lower than that in ibuprofen group [12.6 (5.7, 19.5) ng / L, (45.0 ± 36.9) 10.1, 33.8) ng / L, (73.5 ± 44.8) ng / L, P = 0.031,0.002]. There was no significant difference between the paracetamol group and the ibuprofen group (70.5% vs 76.7%, P = 0.506). Although the incidence of oliguria in the acetaminophen group was significantly lower than that in the ibuprofen group % Than 14.0%), but the difference was not statistically significant (P = 0.108). There was no significant difference in the occult occult blood positive rate, intraventricular hemorrhage, neonatal necrotizing enterocolitis and bronchopulmonary dysplasia between the two groups after treatment (P> 0.05). No significant changes were found in platelet, serum creatinine and alanine aminotransferase in both groups after treatment (P> 0.05). There was no significant difference in the decrease of plasma and urine PGE 2 levels between the two groups (P> 0.05). The decrease of plasma and urinary PGE 2 level in the oliguria group [35.0 (26.3, 49.8) ng / L, (135.0 ± 38.0 ng / L] was significantly greater than that of non-oliguric group [13.3 (6.7, 20.8) ng / L, (52.5 ± 37.0) ng / L, P = 0.001, Plasma and urine PGE 2 levels were highly correlated (r = 0.648, P <0.001). The coefficient of variation of urine PGE 2 0.427 was less than that of plasma PGE 2 0.539. Conclusion The efficacy of oral acetaminophen in the treatment of sPDA in preterm infants is similar to that of ibuprofen with fewer adverse reactions. Acetaminophen decreased the PGE 2 level less than ibuprofen, and the incidence of oliguria may be lower than ibuprofen. Urinary PGE 2 level is more suitable for clinical application than plasma PGE 2 level.