高剂量与常规剂量咖啡因治疗早产儿呼吸暂停症的系统评价

High-dose and Routine-dose Caffeine in the Treatment of Premature Infants with Apnea: a Systematic Review

目的:通过Meta分析评价高剂量与常规剂量咖啡因治疗早产儿呼吸暂停症的效果和安全性,为临床决策提供依据。方法:计算机检索CNKI、WanFang Data、VIP、PubMed、Embase、Sciencedirect、The Cochrane Library和Medline数据库,搜集对比高剂量与常规剂量咖啡因治疗早产儿呼吸暂停症的随机对照试验(RCT),检索时限均为建库至2017年12月。由两名研究者独立筛选文献、提取资料并对纳入研究进行偏倚风险评估后,采用RevMan 5.3软件进行Meta分析。结果:共纳入5个RCTs,累计653例呼吸暂停症早产患儿。Meta分析结果表明,高剂量咖啡因组的患儿呼吸暂停发生率[OR=0.59,95%CI(0.36,0.96),P=0.04]、机械通气率[OR=0.41,95%CI(0.21,0.78),P=0.007]低于常规剂量咖啡因组,高剂量咖啡因组患儿的心动过速发生率高于常规剂量咖啡因组[OR=2.12,95%CI(1.26,3.58),P=0.005],两组死亡率[OR=0.72,95%CI(0.35,1.47),P>0.05]、烦躁不安发生率[OR=1.53,95%CI(0.76,3.09),P>0.05]、喂养不耐受发生率[OR=1.36,95%CI(0.68,2.73),P>0.05]的差异无统计学意义。结论:高剂量咖啡因组相对于常规剂量咖啡因组具有更好的治疗效果,但会增加心动过速的风险。受纳入研究数量和质量的限制,上述结论尚待更多高质量研究予以验证。

Objective:To evaluate the clinical effects of routine-dose caffeine compared with high-dose caffeine for premature infants with apnea by Meta-analysis.Methods:CNKI,WanFang Data,VIP,PubMed,Embase,Sciencedirect,The Cochrane Library and Medline database were electronically searched to collect randomized controlled trial(RCT)of high-dose and routine-dose caffeine in the treatment of apnea in premature infants from inception to December 2017.Two reviewers independently screened literature,extracted data and assessed the risk of bias of included studies.RevMan 5.3 software was used for Meta-analysis.Results:A total of five RCTs and 653 patients were included.The results of Meta analysis showed that apnea frequency(OR=0.59,95%CI 0.36 to 0.96,P=0.04)and extubation failure(OR=0.41,95%CI 0.21 to 0.78,P=0.007)in high-dose group were lower than that in routine-dose group.In addition,the tachycardia rate was higher in high-dose group(OR=2.12,95%CI 1.26 to 3.58,P=0.005).While,there were no significant differences between two groups in death rate(OR=0.72,95%CI 0.35 to 1.47,P>0.05),multiple irritability rate(OR=1.53,95%CI 0.76 to 3.09,P>0.05)and difficulty in feeding(OR=1.36,95%CI 0.68 to 2.73,P>0.05).Conclusion:These results suggest that high-dose caffeine showed significant superior to routine-dose caffeine for treatment and routine-dose caffeine increased the risk of tachycardia significantly.Due to limited quality and quantity of the included studies,more high quality studies are needed to verify above conclusion.