不同维持剂量枸橼酸咖啡因在极低体重早产儿呼吸暂停治疗中的应用价值

Application Value of Different Maintenance Doses of Caffeine Citrate in the Treatment of Very Low Body Weight Premature Infants with Apnea

目的:探究不同维持剂量枸橼酸咖啡因联合经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)在极低体重早产儿呼吸暂停中的应用价值。方法:选择2018年6月-2020年6月在内江市第一人民医院新生儿科住院,确诊为呼吸暂停的极低体重早产儿70例,采用随机数字表法分为高维持剂量枸橼酸咖啡因+nCPAP组(高剂量组,n=35)、低维持剂量枸橼酸咖啡因+nCPAP组(低剂量组,n=35)。两组开始枸橼酸咖啡因均采用相同负荷剂量20 mg/kg,24 h后则分别采用10、5 mg/(kg·d)的维持剂量治疗。比较两组频繁呼吸暂停情况、气管插管比率、nCPAP通气时长、住院时间、治疗有效率、不良反应(心动过速、喂养不耐受)、相关严重并发症(颅内出血、坏死性小肠结肠炎、支气管肺发育不良)发生比例等情况。结果:高剂量组nCPAP通气时间短于低剂量组,治疗有效率高于低剂量组(P<0.05);高剂量组频繁呼吸暂停、气管插管、住院时间>10 d的比例均低于低剂量组,但差异均无统计学意义(P>0.05)。高剂量组心动过速例数多于低剂量组(P<0.05),两组喂养不耐受、IVH、NEC、BPD、PDA、ROP发生率比较,差异均无统计学意义(P>0.05)。结论:高维持剂量橼酸咖啡因在治疗极低体重早产儿呼吸暂停中效果较好,值得临床上推广。

Objective:To explore the application value of different maintenance doses of Caffeine Citrate combined with nasal continuous positive airway pressure(nCPAP)in the treatment of very low body weight premature infants with apnea.Method:A total of 70 extremely low birth weight premature infants admitt to neonatology department of Neijiang First People’s Hospital from June 2018 to June 2020 and diagnose with apnea were divided into high maintenance dose Caffeine Citrate+nCPAP group(high dose group,n=35)and low maintenance dose Caffeine Citrate+nCPAP group(low dose group,n=35)according to the random number table method.Both groups received the same loading dose of Caffeine Citrate of 20 mg/kg at the beginning,and maintenance dose of 10 and 5 mg/(kg·d)after 24 h,respectively.The incidence of frequent apnea,rate of endotracheal intubation,nCPAP duration of ventilation,length of hospital stay,effective rate of treatment,incidence of adverse reactions(tachycardia,feeding intolerance)and related serious complications(intracranial hemorrhage,necrotic enterocolitis,bronchopulmonary dysplasia)were compared between two groups.Result:The ventilation time of nCPAP in high dose group was shorter than that in low dose group,and the effective rate was higher than that in low dose group(P<0.05).The proportions of frequent apnea,endotracheal intubation and hospital stay>10 d in high dose group were lower than those in low dose group,but there were no statistical significances(P>0.05).The number of tachycardia in high dose group was more than that in low dose group(P<0.05),but there were no statistical significances in the incidences of feeding intolerance,IVH,NEC,BPD,PDA and ROP between two groups(P>0.05).Conclusion:High maintenance dose of Caffeine Citrate is effective in the treatment of very low weight premature infants with apnea,it is worthy of clinical promotion.