不同维持剂量枸橼酸咖啡因对极早产儿呼吸暂停辅助通气治疗效果及安全性分析

An Analysis of the Efficacy and Safety of Different Maintenance Doses of Caffeine Citrate in the Treatment of Apnea-assisted Ventilation in Very Preterm Infants

目的探讨不同维持剂量枸橼酸咖啡因对极早产儿呼吸暂停辅助通气治疗效果及安全性。方法单纯随机选取2022年1月—2023年1月泉州市儿童医院收治的70例极早产儿呼吸暂停患儿为研究对象,按照不同剂量的枸橼酸咖啡因分成高剂量组和低剂量组,各35例,所有患儿枸橼酸咖啡因负荷剂量均为20 mg/kg,其中两组的维持剂量分别为:高剂量组10 mg/(kg·d),低剂量组5 mg/(kg·d),两组均连续治疗7 d,比较两组的治疗效果、不良反应及主要并发症发生率、治疗前后的血气分析指标[氧分压(oxygen partial pressure,PaO_(2))、二氧化碳分压(partial pressure of carbon dioxide,PaCO_(2))、氧合指数(oxygen partial pressure/partial pressure of carbon dioxide,PaO_(2)/FiO_(2))]变化。结果治疗后,高剂量组的呼吸暂停发作次数为(2.57±0.95)次,少于低剂量组的(3.31±1.18)次,差异有统计学意义(P<0.05)。治疗后,高剂量组呼吸暂停消失时间(1.03±0.17)d、氧疗时间(16.77±2.83)d、机械通气时间(3.80±0.93)d、住院时间(23.26±2.55)d、咖啡因使用时间(15.11±4.16)d,均短于低剂量组的(1.34±0.48)d、(19.14±2.94)d、(4.37±0.88)d、(24.97±3.18)d、(17.40±4.08)d,差异有统计学意义(t=3.643、3.437、2.640、2.491、2.319,P均<0.05)。治疗后,与同组治疗前比较,两组的PaO_(2)、PaO_(2)/FiO_(2)均升高,且高剂量组的PaO_(2)、PaO_(2)/FiO_(2)均高于低剂量组,差异有统计学意义(P均<0.05)。两组的不良反应及并发症发生率比较,差异无统计学意义(P均>0.05)。结论10 mg/(kg·d)维持剂量的枸橼酸咖啡因应用于极早产儿呼吸暂停患儿可获得良好的治疗效果,明显改善患儿的呼吸功能和氧合状态,且安全性好。

Objective To investigate the efficacy and safety of different maintenance doses of caffeine citrate in the treatment of very premature infants with apnea assisted ventilation.Methods A total of 70 very premature infants with apnea admitted to Quanzhou Children's Hospital from January 2022 to January 2023 were simple randomly selected as the research objects.According to different doses of caffeine citrate,they were divided into high-dose group and low-dose group,with 35 cases in each group.The loading dose of caffeine citrate in all children was 20 mg/kg,and the maintenance doses of the two groups were 10 mg/(kg·d)in the high-dose group and 5 mg/(kg·d)in the low-dose group.Both groups were treated continuously for 7 days.The therapeutic effect,incidence of adverse reactions and major complications,blood gas analysis indexes[oxygen partial pressure(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(PaO_(2)/FiO_(2))]before and after treatment were compared between the two groups.Results After treatment,the number of apnea episodes in the high-dose group was(2.57±0.95)times,which was less than that in the low-dose group(3.31±1.18)times,the differences was statistically significant(P<0.05).After tratment,the disappearance time of apnea was(1.03±0.17)d,the oxygen therapy time was(16.77±2.83)d,the mechanical ventilation time was(3.80±0.93)d,the hospitalization time was(23.26±2.55)d,and the caffeine use time was(15.11±4.16)d in the high-dose group were shorter than(1.34±0.48)d,(19.14±2.94)d,(4.37±0.88)d,(24.97±3.18)d,(17.40±4.08)d in the low-dose group,and the differences were statistically significant(t=3.643,3.437,2.640,2.491,2.319,all P<0.05).After treatment,compared with the same group before treatment,PaO_(2)and PaO_(2)/FiO_(2)in the two groups increased,and PaO_(2)and PaO_(2)/FiO_(2)in the high-dose group were higher than those in the low-dose group,the differences were statistically significant(all P<0.05).There was no significant difference in the incidence of adverse reactions and complications between the two groups(both P>0.05).Conclusion 10 mg/(kg·d)in the higher maintenance dose of folic acid in coffee for extremely premature apnea patients can obtain good therapeutic effect,significantly improve the patient's respiratory function and oxygenation state,and security is good.