不同剂量枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效比较

Comparison on Efficacy of Different Doses of Caffeine in Treatment of Primary Apnea in Premature Infants

目的:探讨不同剂量枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效及安全性。方法:选取开封市儿童医院收治的原发性呼吸暂停早产儿278例,采用随机数字表法分为枸橼酸咖啡因高剂量组与枸橼酸咖啡因低剂量组,每组139例。高剂量组患儿给予枸橼酸咖啡因初始剂量20 mg/kg,维持剂量15 mg/kg;低剂量组患儿给予枸橼酸咖啡因初始剂量20 mg/kg,维持剂量5 mg/kg。观察并比较两组患儿的临床疗效,住院时间,慢性肺病、院内死亡、并发症及不良反应发生率。结果:枸橼酸咖啡因治疗期间,高剂量组患儿呼吸暂停次数显著少于低剂量组[(10.8±2.9)次vs.(18.2±3.6)次]、撤机成功率显著高于低剂量组[84.9%(118/139)vs.69.8%(97/139)]、总有效率显著高于低剂量组[82.0%(114/139)vs.61.2%(85/139)],差异均有统计学意义(P<0.05)。两组患儿院内死亡率、其他并发症发生率、慢性肺病发病率与住院时间等预后指标比较,差异均无统计学意义(P>0.05);两组患儿心动过速、喂养困难、消化紊乱、烦躁不安等不良反应发生率比较,差异均无统计学意义(P>0.05)。结论:枸橼酸咖啡因首剂量20 mg/kg、每日维持剂量15 mg/kg治疗早产儿原发性呼吸暂停,安全性好,疗效高。

OBJECTIVE：To evaluate the efficacy and safety of different doses of caffeine in treatment of primary apnea in premature infants. METHODS： 278 premature infants with primary apnea admitted into Kaifeng Children＇s Hospital were extracted to be divide into high-dose caffeine group and low-dose caffeine group via the random number table, with 139 cases in each. The high-dose caffeine group was treated with initial dose 20 mg/kg, maintenance dose 15 mg/kg, while the low-dose caffeine group received initial dose 20 mg/kg, maintenance dose 5 mg/kg. The clinical efficacy, length of hospital, chronic pulmonary disease, hospital death, and incidence of complications and adverse drug reactions of two groups were observed and compared. RESULTS ： During treatment, the number of apnea in the high-dose group was significantly lower than that in the low-dose group [ （ 10. 8 ± 2. 9） times vs. （ 18.2 ± 3.6） times], yet the success rate of ventilator was significantly higher than that of low-dose group[ 84. 9% （118/139） vs. 69. 8% （97/139） ], and the total effective rate was significantly higher than that of low-dose group [ 82. 0% （114/139） vs. 61.2% （85/ 139） ], with statistically significant difference（P 〈 0. 05 ）. There was no statistically significant difference between two groups in death rate, other complications, incidence of chronic lung disease and length of hospital, etc （P 〉 0. 05 ）. In addition, the difference was not statistically significant in the incidence of adverse drug reactions as tachycardia, feeding intolerance, digestive disorder and dysphoria （ P 〉 0. 05 ）. CONCLUSIONS ： Initial dose 20mg/kg, maintenance dose 15 mg/kg of caffeine in treatment of primary apnea in premature infants has high safety and remarkable efficacy.