不同疗程枸橼酸咖啡因治疗极低出生体质量儿的临床研究

Clinical trial of different courses of caffeine citrate in the treatment of very low birth weight infants

目的对比不同疗程枸橼酸咖啡因注射液对极低出生体质量儿的治疗效果及安全性。方法将极低出生体质量儿分为长疗程组和常规疗程组。2组患儿出生3 d内静脉滴注枸橼酸咖啡因注射液负荷剂量(20 mg·kg^(-1)),在24 h后剂量维持在5 mg·kg^(-1),qd。长疗程组枸橼酸咖啡因注射液用药至矫正胎龄大于34周,常规疗程组枸橼酸咖啡因注射液用药至矫正胎龄33~34周。对比2组患儿枸橼酸咖啡因注射液使用情况、临床疗效、新生儿行为神经量表(NBNA)评分及药物不良反应发生情况。结果本研究最终纳入116例,长疗程组64例、常规疗程组52例。治疗后,长疗程组和常规疗程组患儿总有效率分别为92.19%和94.23%,在统计学上差异无统计学意义(P>0.05)。长疗程组和常规疗程组患儿枸橼酸咖啡因注射液应用总时间分别为(60.53±8.92)和(48.17±5.24)d,停药时矫正胎龄分别为(36.02±1.56)和(33.18±1.27)周,改口服时矫正胎龄分别为(34.31±0.48)和(32.06±0.51)周,改口服时奶量分别为(32.69±2.14)和(23.85±1.69)mL,在统计学上差异均有统计学意义(均P<0.05)。长疗程组和常规疗程组患儿枸橼酸咖啡因注射液应用起始小时龄分别为(59.65±3.42)和(58.35±3.11)h,在统计学上差异无统计学意义(P>0.05)。治疗前,长疗程和常规疗程组NBNA评分分别为(36.49±6.78)和(35.58±4.22)分;治疗后,长疗程和常规疗程组NBNA评分分别为(43.25±6.88)和(44.12±7.42)分;与治疗前比较,2组患儿治疗后NBNA评分均显著升高,在统计学上差异均有统计学意义(均P<0.05);长疗程组和常规疗程组治疗后NBNA评分比较,在统计学上差异无统计学意义(P>0.05)。长疗程组支气管肺发育不良(84.38%vs 51.92%)、血红蛋白浓度降低(18.75%vs 5.77%)发生率均显著高于常规疗程组(均P<0.05)。结论极低出生体质量儿长疗程使用枸橼酸咖啡因注射液至矫正胎龄>34周时不会明显影响临床治疗效果、神经功能及智能发育。

Objective To compare the efficacy and safety of different courses of caffeine citrate injection in the treatment of very low birth weight infants.Methods Very low birth weight infants were divided into long course group and routine course according to cohort method.2 groups of children were given intravenous infusion of caffeine citrate injection loading dose(20 mg·kg^(-1))within 3 days after birth,and the dose was maintained at 5 mg·kg^(-1)after 24 hours(qd).In the long course group,caffeine citrate injection was used to correct gestational age>34 weeks,and in the routine course,caffeine citrate injection was used to correct gestational age 33-34 weeks.The use of caffeine citrate injection,clinical efficacy,neonatal behavioral neurological scale(NBNA)score and the occurrence of adverse drug reactions were compared between the two groups.Results 116 cases were included in this study,64 cases in the long course group and 52 cases in the routine course.After treatment,the total clinical effective rate of the long course group and the routine course was 92.19%and 94.23%,respectively,with no statistical significance(P>0.05).The total duration of caffeine citrate injection were(60.53±8.92)and(48.17±5.24)days,respectively;the corrected gestational age at withdrawal were(36.02±1.56)and(33.18±1.27)weeks,respectively.The corrected gestational age were(34.31±0.48)and(32.06±0.51)weeks;the milk volume were(32.69±2.14)and(23.85±1.69)m L,respectively,with statistical significance(all P<0.05).The starting age of caffeine citrate injection were(59.65±3.42)and(58.35±3.11)h in the long course group and the routine course,respectively,with no statistical significance(P>0.05).Before treatment,the NBNA score of the long course and routine courses were 36.49±6.78 and 35.58±4.22,respectively;the NBNA score of long course and conventional course after treatment were 43.25±6.88 and 44.12±7.42,respectively.Compared with before treatment,NBNA score in both groups were higher after treatment,with statistical significance(all P<0.05).There was no significant difference in NBNA score between the long course group and the routine course(P>0.05).The incidence of bronchopulmonary dysplasia(84.38%vs 51.92%)and decreased hemoglobin concentration(17.75%vs5.77%)in the long course group were significantly higher than those in the routine course(all P<0.05).Conclusion Long-term use of caffeine citrate injection to correct gestational age>34 weeks has no significant effect on clinical treatment,neurological function and intellectual development of very low birth weight infants.