枸橼酸咖啡因预防早产儿视网膜病的疗效观察

目的　探讨枸橼酸咖啡因预防早产儿视网膜病（ROP）的疗效。方法　选择南方医科大学附属佛山市妇幼保健院住院的早产儿（胎龄24~32周）148例，使用随机数字表法分为研究组71例和对照组77例。2组均予早产儿常规治疗；研究组同时予枸橼酸咖啡因20 mg/kg静脉滴注（时间＞30 min），间隔24 h后，给予5 mg/（kg·d）维持量静脉滴注，如疗程期间仍发生呼吸暂停，则予10 mg/（kg·d）维持量，并予物理刺激、氧疗及呼吸支持等促使自主呼吸恢复，至纠正胎龄37周或出院。所有患儿生后第1周及纠正胎龄36周时采用酶联免疫吸附测定（ELISA）法检测血清胰岛素样生长因子1（IGF-1）及血管内皮生长因子（VEGF）水平；生后4周或纠正胎龄32周时开始眼底筛查，统计ROP的发生情况。结果　生后第1周，研究组血清IGF-1及VEGF水平均明显高于对照组（P＜0.05）；至纠正胎龄36周时，对照组血清IGF-1及VEGF水平均明显升高，研究组血清IGF-1及VEGF水平均无明显变化，研究组IGF-1及VEGF水平均低于对照组（P＜0.05）。与对照组相比，研究组总ROP发生率［11.3%（8/71） vs. 46.8%（36/77）］及严重ROP［（Ⅲ~Ⅴ期）发生率1.4%（1/71）vs. 13.0%（10/77）］均明显降低（P＜0.05）。结论　枸橼酸咖啡因对预防ROP发生有积极的效果，并可降低严重ROP的发生率。

The effect of caffeine citrate on prevention of retinopathy of prematurity

Objective　To investigate the effect of caffeine citrate on the prevention of retinopathy in prematurity (ROP). Methods　A total of 148 premature infants (gestational age from 24 to 32 weeks) admitted to Foshan Maternity and Child Healthcare Hospital Affiliated to Southern Medical University were included and randomly divided into study group (71 cases) and control group (77 cases). Both groups were given regular treatment of premature infants. At the same time，thestudy group was given caffeine citrate 20 mg/kg intravenous drip (time > 30 min). After 24-h interval, 5 mg/(kg·d) was given intravenously as maintenance dose. If apnea still occurred during the course of treatment, 10 mg/(kg·d) maintenance dose was given, and physical stimulation, oxygen therapy and respiratory support were given to promote the recovery of spontaneous breathing until the gestational age was corrected to 37 weeks or they discharged from hospital. The serum levels of insulin-like growth factor-1 (IGF-1) and vascular endothelial growth factor (VEGF) were detected by enzyme-linked immunosorbent assay (ELISA) at the first week after birth and 36 weeks of corrected gestational age. Fundus screening was started at 4 weeks after birth or 32 weeks of corrected gestational age, and the incidence of ROP was counted. Results　At the first week after birth, the levels of IGF-1 and VEGF were significantly higher in the study group than those in the control group (P＜0.05). At 36 weeks of corrected gestational age, the serum levels of IGF-1 and VEGF were significantly increased in the control group, while the serum levels of IGF-1 and VEGF had no significant changes in the study group. The serum levels of IGF-1 and VEGF were lower in the study group than those in the control group (P＜0.05). Compared with the control group, the total incidence rate of ROP [11.3% (8/71) vs. 46.8% (36/77)] and the incidence rate of severe ROP [Ⅲ-Ⅴ period, 1.4% (1/71) vs. 13.0% (10/77)] were significantly lower in the study group (P＜0.05). Conclusion　Caffeine citrate has a positive effect on the prevention of ROP and can reduce the incidence rate of severe ROP.