不同维持剂量枸橼酸咖啡因治疗早产儿呼吸暂停的临床效果比较

Comparison of clinical efficacy between different maintenance doses of caffeine citrate for treating apnea of prematurity

目的比较不同维持剂量枸橼酸咖啡因治疗早产儿呼吸暂停的临床疗效及安全性。方法 73例呼吸暂停早产儿按随机数字表法分为A组37例及B组36例。两组均给予常规治疗联合枸橼酸咖啡因治疗,两组的枸橼酸咖啡因首剂给药量均为20 mg/kg,24 h后A组、B组的维持剂量分别为5 mg/(kg·d)、10 mg/(kg·d)。比较两组疗效、72 h内呼吸暂停发生次数、枸橼酸咖啡因治疗时间及并发症发生率。结果 A组治疗有效率为75.68%(28/37),低于B组的94.44%(34/36)(P<0.05)。两组治疗后呼吸暂停发作频次均随时间延长而减少,而B组呼吸暂停发作频次少于A组(P<0.05),B组枸橼酸咖啡因治疗时间短于A组(P<0.05)。两组喂养不耐受、心率加快、高血糖、电解质紊乱、脑出血、支气管肺发育不良、宫外生长迟缓等并发症发生率比较差异均无统计学意义(P>0.05)。结论 10 mg/(kg·d)枸橼酸咖啡因维持剂量治疗早产儿原发性呼吸暂停疗效更佳,且不增加不良反应的发生率。

Objective To compare the clinical efficacy and safety between different maintenance doses of caffeine citrate for treating apnea of prematurity. Methods Seventy-three premature infants with apnea were divided into group A（ n = 37） and group B（ n = 36） using random number table. Both groups received conventional therapy and administration of caffeine citrate. The initial dose of caffeine citrate was20 mg/kg in both groups. After 24 hours,the maintenance doses of group A and group B were 5 mg/（ kg · d） and 10 mg/（ kg · d）respectively. The efficacy,the frequency of apnea within 72 hours of administration,administration duration of caffeine citrate,and incidence rate of complications were compared between the two groups. Results The response rate of group A was lower than that of group B[75. 68%（ 28/37） vs. 94. 44%（ 34/36）; P〈0.05]. After treatment,the frequency of apnea in both groups decreased over time,and the frequency of group B was significantly less than that of group A（ P〈0.05）. The administration duration of caffeine citrate was shorter in group B compared to group A（ P〈0.05）. There were no significant differences in the incidence rates of complications between the two groups,including feeding intolerance,tachycardia,hyperglycemia,electrolyte imbalance,cerebral hemorrhage,bronchopulmonary dysplasia and extrauterine growth retardation（ P〈0.05）. Conclusion Caffeine citrate with the maintenance dose of 10 mg/（ kg·d） can achieve a better efficacy for treating apnea of prematurity,and it does not increase the incidence rates of adverse reactions.