不同剂量枸橼酸咖啡因治疗早产儿呼吸暂停的临床效果及安全性

Clinical effect and safety of different doses of Caffeine Citrate in the treatment of apnea in premature infants

目的探讨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及安全性。方法选取2018年1月~2019年12月岳阳市妇幼保健院新生儿科重症监护室收治的出现呼吸暂停的110例早产儿作为研究对象,按照随机数字表法分为实验组及对照组,每组各55例。两组患儿首次出现呼吸暂停均给予枸橼酸咖啡因负荷量20 mg/kg,间隔24 h后,实验组给予维持量大剂量枸橼酸咖啡因10 mg/(kg·d),对照组给予维持量小剂量枸橼酸咖啡因5 mg/(kg·d)。比较两组患儿的呼吸暂停持续时间、呼吸暂停发作频率、撤机成功率、有创呼吸机使用时间、无创呼吸机使用时间、氧疗持续时间、总住院时间、各种短期并发症发生率。结果实验组患儿的呼吸暂停发作频率低于对照组,呼吸暂停持续时间短于对照组,撤机成功率高于对照组,差异有统计学意义(P<0.05);两组患儿的有创呼吸机使用时间、无创呼吸机使用时间、氧疗持续时间、总住院时间比较,差异无统计学意义(P>0.05);两组患儿的短期并发症(支气管肺发育不良、坏死性小肠结肠炎、动脉导管开放)发生率比较,差异无统计学意义(P>0.05)。结论大剂量枸橼酸咖啡因相对小剂量而言,能更有效地降低患儿的呼吸暂停发作频率,缩短呼吸暂停持续时间,提高撤机成功率,同时并未增加并发症的发生率,具有更好的疗效,值得推广应用。

Objective To explore the clinical effect and safety of Caffeine Citrate at different maintenance doses in the treatment of apnea in premature infants.Methods A total of 110 premature infants with apnea in Neonatal Intensive Care Unit of Yueyang Maternal and Child Health Hospital from January 2018 to December 2019 were selected as the research subjects.According to the random number table method,they were divided into an experimental group and a control group,with 55 cases in each group.Both groups were given a loading dose of Caffeine Citrate with 20 mg/kg for the first occurrence of apnea.After 24 hours,the experimental group was given maintenance dose of high-dose Caffeine Citrate with 10 mg/(kg·d),and the control group was given maintenance dose of low-dose Caffeine Citrate with 5 mg/(kg·d).The duration of apnea,the onset frequency of apnea,the success rate of withdrawal,the duration of invasive ventilator,the duration of non-invasive ventilator,the duration of oxygen therapy,the total length of hospital stay,and the incidence of various short-term complications were compared between the two groups.Results The frequency and duration of apnea in the experimental group were lower than those in the control group,and the success rate of withdrawal was higher than that in the control group,the differences were statistically significant(P<0.05).There were no significant differences in invasive ventilator use time,non-invasive ventilator use time,oxygen therapy duration and total hospital stay between the two groups(P>0.05).There were no significant differences in the incidence rates of short-term complications(bronchopulmonary dysplasia,necrotizing enterocolitis,ductus arteriosus opening)between the two groups(P>0.05).Conclusion Compared with low-dose of Caffeine Citrate,high-dose of Caffeine Citrate can effectively reduce the frequency of apnea attacks in children,shorten the duration of apnea,improve the success rate of withdrawal,and does not increase the incidence of complications.It has better efficacy and is worthy of promotion and application.