不同维持剂量枸橼酸咖啡因在早产儿呼吸暂停中的应用对比观察

  目的  观察不同维持剂量枸橼酸咖啡因在早产儿呼吸暂停中的应用效果。  方法  将舟山市妇女儿童医院2017年6月—2019年6月收治的82例呼吸暂停(AOP)早产儿按照随机数字表法分为高剂量组(41例)和低剂量组(41例)。所有患儿均根据病情需要进行抗感染、呼吸支持等措施，2组均在拔管前24 h予以枸橼酸咖啡因负荷量20 mg/(kg·d)，高剂量组维持剂量10 mg/(kg·d)，低剂量组维持剂量5 mg/(kg·d)，比较2组患儿的疗效、不良反应发生率和并发症发生率。  结果  与低剂量组比较，高剂量组的有效率更高(46.34% vs. 68.29%)，撤机失败率(31.71% vs. 12.20%)、呼吸暂停时间(5.02±1.44)d vs. (2.86±1.03)d]、住院时间(23.56±6.35)d vs. (20.75±5.97)d]均更低，差异均有统计学意义(均P < 0.05)，而2组的药物使用时间、氧疗时间、院内病死率比较，差异无统计学意义(均P>0.05)。2组早产儿心动过速、喂养不耐受、高血糖、电解质紊乱等发生率比较，差异无统计学意义(均P>0.05)。2组早产儿支气管肺发育不良、早产儿视网膜病变、坏死性小肠结肠炎、颅内出血等并发症发生率比较，差异无统计学意义(均P>0.05)。  结论  相比低剂量枸橼酸咖啡因，高剂量枸橼酸咖啡因改善AOP早产儿呼吸功能效果更佳，拔管成功率更高，且未明显增加不良反应，可于临床推广应用。 

Comparative observation of two different doses of caffeine citrate in apnea of preterm infants

  Objective  To study the effects of different doses of caffeine citrate on apnea in preterm infants.  Methods  A total of 82 cases of apnea of prematurity (AOP) preterm infants were divided into high-dose groups (41 cases) and low-dose group (41 cases) according to random number table. All children were appropriately treated with anti-infection, respiratory support and other measures. Both groups were given caffeine citrate load of 20 mg/(kg·d) 24 hours before extubation, maintenance dose of 10 mg/(kg·d) in high-dose group and 5 mg/(kg·d) in low-dose group. The efficacy, adverse reaction rate, and complication rate of the two groups of children were compared.  Results  Compared to the low-dose group, the high-dose group's effective rate was higher (46.34% vs. 68.29%), and the failure rate (31.71% vs. 12.20%), apnea time (5.02±1.44) d vs. (2.86±1.03) d], and length of hospital stay (23.56±6.35) d vs. (20.75±5.97) d] were lower, which differences were statistically significant (all P < 0.05). There was no significant difference in hospital stay time, oxygen treatment time, and in-hospital mortality between the two groups (all P>0.05). There was no significant difference in the incidence of tachycardia, feeding intolerance, hyperglycemia, and electrolyte disturbance between the two groups (all P>0.05). There was no significant difference in the incidence of bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), necrotizing enterocolitis (NEC), intra-ventricular hemorrhage (IVH) and other complications in both groups (all P>0.05).  Conclusion  Compared with low-dose caffeine citrate, high-dose caffeine citrate has a higher success rate of extubation, improves the respiratory function of preterm infants with AOP, and doesn't increase significantly in adverse reactions, which have clinical application meaning.