不同时机应用枸橼酸咖啡因对早产儿结局及神经发育影响的比较研究

Comparison of the effects of caffeine citrate administering at different time on outcome and neuro-development of premature infants

目的探讨不同时机应用枸橼酸咖啡因对早产儿结局及神经发育的影响。方法选取2018年1月至6月于我院新生儿重症监护室住院治疗的胎龄小于32周、体重小于1500 g的早产儿共113例为研究对象,按开始使用枸橼酸咖啡因的日龄分为早期治疗组(日龄≤1 d,53例)和晚期治疗组(1 d<日龄≤10 d,60例),回顾性收集并比较两组患儿围生期的基本情况、治疗过程、临床结局,并针对神经发育情况随访至12月龄。结果早期治疗组患儿支气管肺发育不良、动脉导管未闭及脑室内出血/脑室周围白质软化的发生率低于晚期治疗组,差异均有统计学意义(均P<0.05)。早期治疗组纠正胎龄40周时新生儿神经行为测定评分高于晚期治疗组,差异有统计学意义(P<0.05)。早期治疗组纠正胎龄3月龄时智力发育指数高于晚期治疗组,纠正胎龄至12月龄时智力发育指数及运动发育指数均高于晚期治疗组,差异均有统计学意义(均P<0.05)。结论早期应用枸橼酸咖啡因可改善早产儿结局,改善神经系统预后。

Objective To investigate the effect of caffeine citrate administering at different time on outcome and neurodevelopment of premature infants.Methods A total of 113 preterm infants with gestational age less than 32 weeks and birth weight less than 1500 g who were hospitalized and treated in the neonatal intensive care unit from January 2018 to June 2018 were enrolled.According to the time when caffeine citrate treatment was started,they were divided into early treatment group(≤1 days)with 53 infants and late treatment group(1 to 10 days)with 60 infants.A retrospective analysis was performed for their clinical data.The perinatal conditions,treatment process and clinical outcomes of the two groups were compared and the neurological development was followed up at 12 months old.Results Compared with the late treatment group,the early treatment group had a significantly shorter durations of mechanical ventilation time,oxygen therapy time,hospitalization days and a significantly lower incidence of bronchopulmonary dysplasia,patent ductus arteriosusand intraventricular hemorrhage or periventricular leukomalacia,and there were significant differences between two groups(P<0.05,respectively).The neonatal behavioral neurological assessment score in the early treatment group was higher than that in the late treatment group at 40 weeks of gestational age,and there was significant difference between two groups(P<0.05).The mental developmental index at 3 months of corrected age,the mental developmental index and psychomotor developmental index at 12 months were significantly better in the early treatment group than those in the late treatment group,and there were significant differences between two groups(P<0.05,respectively).Conclusion Early use of caffeine citrate can improve the outcome of premature infants and improve the prognosis of nervous system.