不同剂量枸橼酸咖啡因对呼吸暂停新生儿肠道菌群的影响研究

目的:探讨不同剂量枸橼酸咖啡因对呼吸暂停新生儿肠道菌群的影响。方法:回顾性选取2018年1月至2020年7月合肥市滨湖医院收治的呼吸暂停新生儿110例,依据枸橼酸咖啡因给药方式的不同分成低剂量组和高剂量组。低剂量组患儿(55例)的首次负荷量为静脉滴注枸橼酸咖啡因20 mg/kg,加入5%葡萄糖注射液3 ml以输液泵维持30 min,24 h后取枸橼酸咖啡因5 mg/kg静脉滴注,加入5%葡萄糖注射液3 ml以输液泵维持30 min,之后每间隔24 h用药1次。高剂量组患儿(55例)首次负荷量给药方式同低剂量组,24 h后给予枸橼酸咖啡因10 mg/kg,加入5%葡萄糖注射液3 ml以输液泵维持30 min,之后每间隔24 h用药1次。两组患儿均连续治疗至呼吸暂停症状消失后7 d停药。观察两组患儿的肠道菌群情况、临床疗效和不良反应发生情况。结果:与低剂量组比较,高剂量组患儿治疗第7日时革兰阳性球菌、革兰阴性球菌计数较高,而革兰阴性杆菌计数较低,差异有统计学意义(P<0.05)。低剂量组患儿的总有效率为98.18%(54/55),明显高于高剂量组的87.27%(48/55),差异有统计学意义(P<0.05)。治疗第1日时,低剂量组与高剂量组患儿呼吸暂停发作次数、严重程度的差异无统计学意义(P>0.05);相较于治疗第1日时,两组患儿治疗第3日的呼吸暂停发作次数明显减少,严重程度评分明显降低,且治疗第3日两组间比较的差异有统计学意义(P<0.05)。高剂量组患儿喂养不耐受发生率为18.18%(10/55),明显高于低剂量组的5.45%(3/55),差异有统计学意义(P<0.05)。结论:枸橼酸咖啡因可破坏新生儿正常肠道菌群的建立,因此,在确保疗效的同时应尽量减少使用剂量,降低药物对肠道微生态的损伤,提高治疗安全性。

Effects of Different Doses of Caffeine Citrate on Intestinal Flora of Neonates With Apnea

OBJECTIVE:To explore the effects of different doses of caffeine citrate on intestinal flora of neonates with apnea.METHODS:Totally 110 neonates with apnea admitted into Hefei Binhu Hospital from Jan.2018 to Jul.2020 were retrospectively extracted to be divided into low-dose group and high-dose group according to different administration methods of caffeine citrate.In the low-dose group(n=55),the initial load was 20 mg/kg caffeine citrate with 3 ml 5%glucose injection infusion pump for 30 min,after 24 h,5 mg/kg caffeine citrate was intravenously injected,and 3 ml 5%glucose injection was added to the infusion pump for 30 min,and then medication was given once every 24 h.In the high-dose group(n=55),the initial dose was the same as the low-dose group,after 24 h,10 mg/kg caffeine citrate was given,and 3 ml 5%glucose injection was added to the infusion pump for 30 min,and then medication was given once every 24 h.Both groups were treated continuously until one week after the disappearance of apnea symptoms.The intestinal flora,clinical efficacy and adverse drug reactions of two groups were observed.RESULTS:Compared with the low-dose group,after 7 d of treatment,the counts of G+and G-were higher in the high-dose group,while the counts of G-were lower,with statistically significant difference(P<0.05).The total effective rate of the low-dose group was 98.18%(54/55),significantly higher than that of the high-dose group of87.27%(48/55),the difference was statistically significant(P<0.05).On the first day of treatment,there was no significant difference in the frequency and severity of apnea between the low-dose group and the high-dose group(P>0.05).Compared with the first day of treatment,the frequency of apnea and the severity score decreased significantly in both groups on the third day of treatment,and the difference was statistically significant(P<0.05).The incidence of feeding intolerance in the high-dose group was 18.18%(10/55),significantly higher than that in the low-dose group 5.45%(3/55),the difference was statistically significant(P<0.05).CONCLUSIONS:Caffeine citrate can destroy the establishment of normal intestinal flora in neonates.Therefore,the dosage should be reduced as far as possible while ensuring the efficacy,reducing the damage of drugs to intestinal microecology and improving the safety of treatment.