咖啡因对早产儿呼吸暂停的治疗效果及安全性分析

Effect and Safety Analysis of Caffeine for Preterm Children with Apnea

探讨咖啡因对早产儿呼吸暂停的治疗效果和安全性。方法选取2013年9月至2014年8月成都市妇女儿童中心医院接诊的90例呼吸暂停早产儿作为研究对象,按照随机数表字法分为观察组和对照组,各45例。观察组给予咖啡因静脉滴注,首次剂量为20.0 mg/kg,24 h后以5 mg/kg的剂量维持用药,每24小时应用1次;对照组给予氨茶碱静脉滴注,首次剂量为5 mg/kg,12 h后以2.5 mg/kg的剂量持续用药,每12小时应用1次。两组均连续治疗7 d。观察两组患儿用药后的临床效果,治疗前后血浆β-内啡肽(β-EP)、动脉血二氧化碳分压(Pa CO2)、动脉血氧分压(Pa O2)指标变化,以及呼吸暂停和不良反应发生情况。结果观察组总有效率高于对照组[95.6%(43/45)比84.4%(35/45)],差异有统计学意义(P<0.05)。治疗后,观察组血浆β-EP和Pa CO2低于对照组[(118±12)ng/L比(165±15)ng/L,(41±4)mm Hg(1 mm Hg=0.133 k Pa)比(46±5)mm Hg],Pa O2高于对照组[(81±4)mm Hg比(69±6)mm Hg],差异有统计学意义(P<0.01)。观察组早产儿呼吸暂停次数、呼吸暂停时间低于对照组[(1.8±0.3)次比(3.6±1.4)次,(16.9±2.7)min比(21.5±2.4)min],血氧饱和度和心率高于对照组[0.87±0.12比0.72±0.12,(95±12)次/min比(82±13)次/min],差异有统计学意义(P<0.01)。观察组呼吸暂停、死亡、胎头双顶径、视网膜脱落、脑损伤的发生率均低于对照组[2.2%(1/45)比20.0%(9/45),4.4%(2/45)比20.0%(9/45),4.4%(2/45)比17.8%(8/45),2.2%(1/45)比15.6%(7/45),6.7%(3/45)比20.0%(9/45)],差异有统计学意义(P<0.05)。结论咖啡因治疗早产儿呼吸暂停能够使血浆β-EP和Pa CO2水平降低,Pa O2水平升高,提高疗效和安全性。

Objective To investigate the effect and safety of caffeine for preterm children with apnea.Methods Total of 90 preterm children with apnea in Chengdu Women and Children＇s Central Hospital from Sep. 2013 to Aug. 2014 were included in the study. According to the random number table method,they were divided into observation group and control group（ 45 cases each）. The observation group was given caffeine treatment by intravenous infusion at the dose of 20. 0 mg / kg,then changed to the maintenance dose of5 mg / kg after 24 hours,once per 24 hours; the control group received intravenous aminophylline therapy,at the starting dose of 5 mg / kg,then changed to the maintenance dose of 2. 5 mg / kg after 12 hours,once per 12 times. Both groups were treated continuously for 7 d. The clinical results,the plasma β-endorphin（ β-EP）,arterial carbon dioxide partial pressure（ Pa CO2） and partial pressare of oxygen（ Pa O2）,and the apnea and adverse reactions of the two groups were compared. Results Effective rate of the observation group was significantly higher than control group[95. 6%（ 43 /45） vs 84. 4%（ 35 /45） ],the difference was statistically significant（ P〈0. 05）. The β-EP and Pa CO2 of the observation group were lower than the control group[（ 118 ± 12） ng/L vs（ 165 ± 15） ng/L,（ 41 ± 4） mm Hg vs（ 46 ± 5） mm Hg],Pa O2 was higher than the control group[（ 81 ± 4） mm Hg vs（ 69 ± 6） mm Hg],the difference was statistically significant（ P〈0. 01）.The times of apnea,time of apnea of the observation group were significantly lower than the control group[（ 1. 8 ± 0. 3） times vs（ 3. 6 ± 1. 4） times,（ 16. 9 ± 2. 7） min vs（ 21. 5 ± 2. 4） min],the oxygen saturation and heart rate of the observation group were significantly higher than the control group[0. 87 ± 0. 12 vs0. 72 ± 0. 12,（ 95 ± 12） times / min vs（ 82 ± 13） times / min ],the differences were statistically significant（ P〈0. 01）. The incidence of apnea,death,biparietal diameter,retinal detachment,brain injury of the observation group were significantly lower than the control group[2. 2%（ 1 /45） vs 20. 0%（ 9 /45）,4. 4%（ 2 /45）vs 20. 0%（ 9 /45）,4. 4%（ 2 /45） vs 17. 8%（ 8 /45）,2. 2%（ 1 /45） vs 15. 6%（ 7 /45）,6. 7%（ 3 /45） vs20. 0%（ 9 /45） ],the differences were statistically significant（ P〈0. 05）. Conclusion Caffeine has a good effect for apnea of preterm children,it can reduce plasma β-EP and Pa CO2 level and increase Pa O2 levels,which can improve the efficacy and safety.