咖啡因不同起始用药时间对极低出生体重儿近期预后的影响

Effect of Caffeine Initiation Time on Short-Term Prognosis of Very Low Birth Weight Infants

目的探讨咖啡因不同起始用药时间对极低出生体重儿近期预后的影响。方法选择2021年1—12月江西省妇幼保健院收治的胎龄<34周、出生体重≤1250 g的极低出生体重儿160例,采用随机数字表法分为试验组和对照组,每组80例。试验组于生后3 d内给予枸橼酸咖啡因治疗,对照组于生后4~7 d给予枸橼酸咖啡因治疗。枸橼酸咖啡因首次剂量20 mg·kg^(-1),静脉滴注,24 h后予维持量10 mg·kg^(-1)·d^(-1),持续观察至患儿纠正胎龄出院。比较2组患儿有创呼吸机辅助通气时间、无创呼吸机辅助通气[包括无创高频通气(nHFO)、经鼻间歇正压通气(NIPPV)、经鼻持续气道正压通气(CPAP)]时间及高流量鼻导管吸氧时间;比较2组患儿并发症[包括支气管肺发育不良(BPD)、早产儿视网膜病变(ROP)、呼吸机相关性肺炎(VAP)、坏死性小肠结肠炎(NEC)、脑损伤]及呼吸暂停发生率。结果试验组患儿接受有创呼吸机辅助通气、无创呼吸机辅助通气时间低于对照组,高流量鼻导管吸氧时间高于对照组,差异有统计学意义(均P<0.05)。试验组患儿BPD、VAP、ROP及呼吸暂停发生率低于对照组(均P<0.05),2组NEC和脑损伤发生率比较差异无统计学意义(P>0.05)。结论早期应用咖啡因能降低患儿对呼吸机的需求,有助于更早拔管、撤离有创呼吸机,减少BPD、VAP及呼吸暂停的发生,更好地预防ROP的发生,且并未增加NEC、脑损伤的发生率。

Objective To investigate the effect of caffeine initiation time on short-term prognosis of very low birth weight(VLBW)infants.Methods A total of 160 VLBW infants(gestational age<34 weeks,birth weight≤1250 g)admitted to Jiangxi Maternal and Child Health Hospital from January 2021 to December 2021 were randomly assigned to receive caffeine citrate either within 3 days after birth(experimental group,80 infants)or between 3-7 days after birth(control group,80 infants).All the infants were firstly given intravenous drip of 20 mg·kg^(-1)citrate caffeine,followed by maintenance dose of citrate caffeine(10 mg·kg^(-1)·d^(-1))after 24 h.The infants were kept under observation until discharge.Invasive mechanical ventilation,noninvasive mechanical ventilation duration(noninvasive high-frequency oscillation(nHFO),nasal intermittent positive pressure ventilation(NIPPV)and nasal continuous positive airway pressure(CPAP)),high-flow nasal cannula oxygen therapy duration,and incidences of bronchial pulmonary dysplasia(BPD),retinopathy of prematurity(ROP),ventilator associated pneumonia(VAP),necrotizing enterocolitis(NEC),cerebral injury and apnea were compared between the two groups.Results The duration of invasive and noninvasive mechanical ventilation in the experimental group was shorter than that in the control group(P<0.05).The incidences of BPD,VAP,ROP and apnea in the experimental group were lower than those in the control group(P<0.05).The duration of high-flow nasal cannula oxygen therapy in the experimental group was longer than that in the control group(P<0.05).There were no significant differences in the incidences of NEC and cerebral injury between the two groups(P>0.05).Conclusion Early application of caffeine reduces the need for ventilator,facilitates earlier extubation and withdrawal of invasive ventilation,decreases the incidences of BPD,VAP and apnea,prevents the occurrence of ROP,and does not increase the incidences of NEC and brain injury.