预防性使用枸橼酸咖啡因对早产儿原发性呼吸暂停及相关并发症的影响

目的 分析预防性使用枸橼酸咖啡因对早产儿原发性呼吸暂停发生及相关并发症的影响。方法 选择2014年6月-2017年5月西北妇女儿童医院出生的胎龄<32周、出生体重<1 500 g的早产儿,随机分为枸橼酸咖啡因预防组(n=539)和治疗组(n=557),预防组生后立即开始用药,治疗组发生原发性呼吸暂停后开始用药,比较两组用药后呼吸暂停发生率、用氧时间、无创和有创通气时间,以及支气管肺发育不良、颅内出血、坏死性小肠结肠炎、早产儿视网膜病的发生率。结果 预防组患儿呼吸暂停发生率、用氧时间、有创通气和无创通气时间均小于治疗组10.0% vs.19.7%,(29.0±4.7)d vs.(35.0±4.2)d,(1.0±1.7)d vs.(2.6±1.5)d,(1.7±1.2)d vs.(2.4±1.3)d],差异均有统计学意义(P<0.05)。预防组支气管肺发育不良、颅内出血、坏死性小肠结肠炎和早产儿视网膜病发生率均低于治疗组(11.7% vs.16.2%、10.0% vs.14.7%、5.2% vs.8.8%、9.1% vs.13.2%),差异有统计学意义(P<0.05)。结论 预防性使用枸橼酸咖啡因可明显降低呼吸暂停及相关并发症的发生率。

Efficacy of caffeine citrate for preventive use in the prophylactic treatment of primary apnea and related complications in premature infants

Objective To analyze the efficacy of caffeine citrate for preventive use in the prophylactic treatment of primary apnea and related complications in premature infants. Methods The preterm infants born in Northwest Women′s and Children′s Hospital from June 2014 to May 2017 and with gestational age under 32 weeks and birth weight under 1 500g after birth were randomly divided into caffeine citrate prevention group(n=539) and treatment group(n=557).Children began to use caffeine citrate immediately after birth in the prevention group, while started to use caffeine citrate after the onset of primary apnea after birth in the treatment group.The rate of apnea, the duration time for using oxygen and invasive and non-invasive mechanical ventilation, as well as the incidence of bronchopulmonary dysplasia(BPD),intercranial hemorrhage(ICH),necrotizing enterocolitis(NEC) and retinopathy of prematurity(ROP) were compared between prevention group and treatment group. Results The rate of the apnea and the duration time for oxygen, invasive and non-invasive mechanical ventilation in the caffeine citrate prevention group were significantly lower than those in the treatment group 10.0% vs.19.7%,(29.0±4.7)d vs.(35.0±4.2)d,(1.0±1.7)d vs.(2.6±1.5)d,(1.7±1.2)d vs.(2.4±1.3)d, all P<0.05].The incidence rates of BPD, ICH, NEC and ROP in the caffeine citrate prevention group were also significantly lower than those in the treatment group(11.7%vs.16.2%,10.0%vs.14.7%,5.2% vs.8.8%,9.1%vs.13.2%, all P<0.05). Conclusion Preventive use of caffeine citrate for use in the prophylactic treatment can significantly reduce the incidence of apnea and related complications.