不同剂量枸橼酸咖啡因在胎龄≤32周NRDS患儿中的应用效果

Application Effect of Different Doses of Caffeine Citrate on NRDS Children with Gestational Age≤32 Weeks

目的:探究不同剂量枸橼酸咖啡因在胎龄≤32周新生儿呼吸窘迫综合征(NRDS)患儿中的应用价值的差异。方法:选取2020年2月-2022年2月于抚州市第一人民医院出生的80例NRDS早产儿,采用简单随机法分为高剂量组(n=40)和低剂量组(n=40)。两组患儿均给予常规治疗方案,同时高剂量组患儿联合使用10 mg/kg枸橼酸咖啡因进行治疗,低剂量组患儿联合使用5 mg/kg枸橼酸咖啡因进行治疗,两组患儿均于呼吸暂停消失7 d后停止用药。比较两组患儿治疗期间临床症状(呼吸暂停次数、呼吸暂停持续时间、撤机成功率、机械通气时长);比较两组患儿治疗前及停药后神经指标[运动发育指数(PDI)、智力发育指数(MDI)、新生儿神经行为测定(NBNA)]、血气指标[血氧分压(PaO_(2))、动脉血pH值、动脉血二氧化碳分压(PaCO_(2))]、肺功能指标[潮气量(TV)、呼吸频率(RR)、每分通气量(MV)];并记录两组不良反应(心动过速、喂养耐受性差、贫血、呕吐、烦躁不安)发生情况。结果:高剂量组呼吸暂停次数少于低剂量组,呼吸暂停持续时间、机械通气时长均短于低剂量组,撤机成功率高于低剂量组(P<0.05)。停药后,两组NBNA、MDI、PDI、PaO_(2)、MV、TV均高于治疗前,且高剂量组均高于低剂量组(P<0.05);停药后,两组患儿PaCO_(2)、RR均低于治疗前,且高剂量组均低于低剂量组(P<0.05)。停药后,两组患儿p H值与治疗前比较,差异均无统计学意义(P>0.05),且高剂量组与低剂量组相比差异无统计学意义(P>0.05)。治疗期间,高剂量组患儿烦躁不安发生率低于低剂量组(P<0.05);两组心动过速、喂养耐受性差、贫血、呕吐发生率比较,差异均无统计学意义(P>0.05)。结论:高剂量枸橼酸咖啡因可有助于NRDS患儿神经及肺发育,提高患儿撤机成功率,并不易增加不良反应风险,安全性较高。

Objective:To explore the differences in application value of different Caffeine Citrate doses on children with neonatal respiratory distress syndrome(NRDS)with gestational age≤32 weeks.Method:A total of 80 premature infants with NRDS born in First People's Hospital of Fuzhou from February 2020 to February 2022 were selected,they were divided into high-dose group(n=40)and low-dose group(n=40)by the simple randomization method.Both groups of children were treated with conventional treatment regimen,and high-dose group was additionally given 10 mg/kg Caffeine Citrate,while low-dose group was treated with 5 mg/kg Caffeine Citrate.All children in both group stopped taking the medicine at 7 d after the apnea disappeared.The clinical symptoms(the number of apnea,duration of apnea,success rate of weaning,duration of mechanical ventilation)during treatment were compared between the two groups;neurological indicators[psychomoter development index(PDI),mental development index(MDI),neonatal behavioral neurological assessment(NBNA)]and blood gas indicators[partial pressure of blood oxygen(PaO 2),arterial blood pH value,partial pressure of arterial blood carbon dioxide(PaCO 2)],pulmonary function indicators[tidal volume(TV),respiratory rate(RR),minute ventilation(MV)]before treatment and after drug withdrawal were compared between the two groups;the occurrence of adverse reactions(tachycardia,poor feeding tolerance,anemia,vomiting,dysphoria)of both groups were recorded.Result:The number of apnea in the high-dose group was less than that in the low-dose group,the duration of apnea and mechanical ventilation were shorter than those in the low-dose group,and the success rate of weaning was higher than that in the low-dose group(P<0.05).After drug withdrawal,NBNA,MDI,PDI,PaO_(2),MV and TV in both groups were higher than those before treatment,those in high-dose group were higher than those in low-dose group(P<0.05).After drug withdrawal,PaCO 2 and RR in both groups were lower than those before treatment,those in high-dose group were lower than those in low-dose group(P<0.05).After drug withdrawal,there were no significant differences in pH value between the two groups compared with those before treatment(P>0.05),and there was no significant difference between the high-dose group and the low-dose group(P>0.05).During treatment,the incidence of agitation in high-dose group was lower than that in low-dose group(P<0.05);there were no significant differences in the incidence of tachycardia,poor feeding tolerance,anemia and vomiting between the two groups(P>0.05).Conclusion:High-dose Caffeine Citrate can help the developments of nerves and lungs in children with NRDS,and enhance the success rate of weaning,and it is not easy to increase the risk of adverse reactions,with high safety.