咖啡因不同维持方式预防早产儿呼吸暂停的效果

Different maintenance methods of caffeine for prevention of apnea of prematurity

目的探究两种咖啡因维持方式预防呼吸暂停(apnea of prematurity,AOP)的有效性和安全性,以达到简化临床使用咖啡因的目的。方法选取2018年1月至2020年12月收治的孕周<32周、体质量<1500 g、生后3 d内开始使用咖啡因的早产儿310例,分为维持剂量固定组(出生体质量×10 mg/kg,n=166)和维持剂量变化组[5 mg/(kg·d),随体质量增加而增加,n=144]。比较两组患儿的AOP预防效果、并发症、不良反应及临床结局。结果维持剂量固定组中频繁出现呼吸暂停、需额外增加咖啡因剂量及提高呼吸支持强度的发生率低于维持剂量变化组(P<0.05),但两组AOP发生率、呼吸机支持时间、住院时间、呼吸暂停时间及出生体重恢复时间差异均无统计学意义(均P>0.05)。两组早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、支气管肺发育不良(broncho pulmonary dysplasia,BPD)、脑室内出血(intraventricular hemorrhage,IVH)、晚发型败血症、心动过速、喂养不耐受及需治疗的早产儿视网膜病变(retinopathy of prematurity,ROP)和动脉导管未闭(patent ductus arteriosus,PDA)的发生率差异无统计学意义(均P>0.05)。结论出生体质量×10 mg/kg的每日固定剂量维持可有效改善早产儿呼吸暂停,并且可能减少频繁的医嘱更改而导致的临床工作负担和患儿安全风险。

Objective To compare the efficacy and safety of two maintenance methods of caffeine for the prevention of apnea of prematurity(AOP)so as to simplify the maintenance method of caffeine.Methods Totally,310 preterm infants with gestational age of less than 32 weeks,birth weight of less than 1500 g,and beginning use of caffeine within 3 days after birth admitted from January 2018 to December 2020 were enrolled as subjects in the study.The subjects were divided into two groups:fixed dose maintenance group[birthweight×10 mg/(kg·d),n=166]and modified maintenance dose group(variant birthweight×5 mg/kg,n=144).The prevention effect,complications,adverse reactions and clinical outcomes were compared between the two groups.Results The incidence rate of apnea,the rate of additionally increasing caffeine dose and the rate of improving respiratory support in the fixed maintenance dose group were all significantly lower than those in the modified maintenance dose group(P<0.05).However,there were no significant differences in the incidence of AOP,duration of ventilation,hospital stay,duration of apnea and birth weight recovery between the two groups(P>0.05).There were no significant differences either in the rates of necrotizing enterocolitis,broncho pulmonary dysplasia,intraventricular hemorrhage,late-onset sepsis,tachycardia,feeding intolerance,retinopathy of prematurity and patent ductus arteriosus(P>0.05).Conclusions The maintenance with fixed dose(birthweight×10 mg/kg)is an effective way in preventing apnea of prematurity.It may reduce the clinical workload and improve the patient safety from the frequent changes of the dose of caffeine.