枸橼酸咖啡因对呼吸暂停早产儿呼吸暂停频率、拔管成功率及肺功能影响

Effect of Caffeine Citrate on Apnea Frequency, Extubation Success Rate and Lung Functions in Preterm Infants with Apnea

目的:探讨枸橼酸咖啡因对呼吸暂停早产儿呼吸暂停频率、拔管成功率及肺功能指标的影响。方法:选取2014年4月-2016年1月我院收治的120例呼吸暂停早产儿作为研究对象,按随机数字表法分为对照组与观察组,各60例。两组均接受常规机械通气治疗,对照组加用氨茶碱(首次负荷剂量为5.0 mg/kg,0.5 h静脉滴注,维持剂量2.5 mg/kg,q12h),观察组加用枸橼酸咖啡因(首次负荷剂量为20.0 mg/kg,0.5 h静脉滴注,维持剂量5.0~10.0 mg/kg,q24h),记录两组治疗情况,比较治疗前后患儿呼吸暂停频率的变化、首次拔管成功率及停药后再次辅助通气率,比较两组患儿肺功能指标:每分钟肺通气量、潮气量、吸呼比、呼吸频率、呼气流量峰值(PEF)、达峰时间比的改善情况,统计不良反应发生率。结果:观察组机械通气时间、用氧时间、拔管时间、住院时间均短于对照组(P<0.05)。治疗前,两组呼吸暂停发生频率比较差异无统计学意义(P>0.05);治疗后,观察组呼吸暂停发生频率、再次辅助通气率均低于对照组(P<0.05),两组首次拔管成功率比较无统计学意义(P>0.05)。观察组每分钟肺通气量、潮气量、吸呼比、呼气流量峰值、达峰时间比均高于对照组(P<0.05)。观察组喂养不耐受、低血钾、多尿等不良反应发生率均低于对照组(P<0.05)。结论:在呼吸暂停早产儿的临床治疗中,于常规机械通气治疗的基础上加用枸橼酸咖啡因,安全性高,可缩短拔管时间,降低呼吸暂停发生频率,改善肺功能。

Objective:To investigate the effect of citrate caffeine on apnea frequency, extubation success rate and lung function indexes in preterm infants with apnea. Methods:120 cases of preterm infants with apnea admitted to our hospital from April 2014 to January 2016 were used as study subjects and divided into control group and observation group according to the random number table method, 60 cases in each group. The patients in the two groups received conventional mechanical ventilation therapy. The patients in the control group were further treated with aminophylline(first loading dose of 5.0 mg/kg, 0.5 h of intravenous drip, maintenance dose of 2.5 mg/kg, q12 h), and the patients in the observation group were further treated with caffeine citrate(first loading dose of 20.0 mg/kg, 0.5 h of intravenous drip, maintenance dose of 5.0~10.0 mg/kg, q24 h). The treatment of the two groups was recorded; the changes in apnea frequency, the success rate of the first extubation and auxiliary ventilation rate of two groups before and after treatment were compared; lung function indexes of the apnea infants in the two groups: lung ventilation volume per min, tidal volume, inhalation/expiration ratio, respiratory frequency, peak expiratory flow(PEF) and peak time ratio improvement were compared and the incidence of adverse reactions was counted. Results:The mechanical ventilation time, oxygen consumption time, extubation time, hospitalization time in the observation group were shorter than those in the control group(P<0.05). There was no significant difference in apnea frequency before treatment between the two groups(P>0.05); the apnea frequency and auxiliary ventilation rate after treatment in the observation group were lower than those in the control group(P<0.05); there was no statistical difference in the first extubation success rate between the two groups(P>0.05). The lung ventilation volume, tidal volume, inhalation/expiration ratio, peak expiratory flow, peak time ratio in the observation group were higher than those in the control group(P<0.05). The incidences of feeding intolerance, hypokalemia, polyuria and other adverse reactions in the observation group were lower than those in the control group(P<0.05). Conclusion:In the clinical treatment of preterm infants with apnea, additionally used caffeine citrate on the basis of conventional mechanical ventilation therapy has high safety, and can shorten extubation time, lower apnea frequency and improve lung functions.