目的 对比枸橼酸咖啡因与氨茶碱防治极低出生体重儿呼吸暂停的疗效。方法 以本院2013年3月-2015年3月收治的100例极低出生体重儿作为试验对象。其中以2013年3月-2014年3月收治的极低出生体重儿48例为对照组:使用氨茶碱治疗,首剂负荷剂量5 mg/kg,30 min静脉泵入,12 h后给予维持剂量2 mg/kg,每12 h 1次,静脉泵入;以2014年3月-2015年3月收治的极低出生体重儿52例为观察组:使用枸橼酸咖啡因治疗,首剂负荷剂量20 mg/kg,静脉泵入,24 h后给予维持剂量5 mg/kg,每24 h 1次,静脉泵入。比较两组患儿呼吸暂停发生率、氧疗时间、达到全肠道喂养的时间、脑室内出血、坏死性小肠炎、早产儿视网膜病、支气管肺发育不良等并发症的发生率及病死率。结果 1)观察组早产儿呼吸暂停发生率较对照组低,且差异有统计学意义(P<0.05);2)两组患儿脑室内出血、支气管肺发育不良、早产儿视网膜病的发生率及辅助通气率低于对照组,且差异有统计学意义[9(18.7%) vs 3(5.7%),χ²=3.98,P<0.05] ;[19(39.6%) vs 10(19.2%),χ²=5.05,P<0.05];[10(20.8%) vs 2(3.8%),χ²=6.85,P<0.05];[18(37.5%) vs 10(19.2%),χ²=4.04,P<0.05];3)两组患儿在坏死性小肠炎的发生率、病死率、氧疗时间、达到全肠道喂养的时间等方面差异无统计学意义(P均>0.05)。结论 枸橼酸咖啡因在防治早产儿呼吸暂停疗效及改善早产儿近期预后优于氨茶碱,但远期预后有待于进一步随访。

Objective To compare the efficacy of caffeine citrate and aminophylline in treatment of apnea of very low birth weight (VLBW) infants. Methods Totally 100 VLBW infants who were born and inhospitaled at our hospital during March 2013 to March 2015 were analyzed.48 VLBW infants during March 2013 to March 2014 were control group,52 VLBW infants during March 2014 to March 2015 were test group.The control group infants were given aminophylline during the treatment:a loading dose of 5 mg/kg for 30 minutes intravenous infusion,a dose of 2 mg/kg after 12 hours,and once every 12 hours.The test group infants were gave caffeine citrate treatment during the treatment:a loading dose of 20 mg/kg for intravenous infusion,a dose of 5 mg/kg after 24 hours,and once per day.The situations of incidence of apnea,duration of oxygen therapy,reaching full milk-feeding time,intravascular hemorrhage (IVH),necrotizing enterocolitis (NEC),retinopathy of prematurity (ROP),bronchopulmonary dysplasia (RPD) and mortality rate of two groups were compared. Results 1)Compared with the control group,the apnea incidence of test group's premature infants was decreased,and the difference was statistically significant(P<0.05);2)Compared with the control group,the test group had lower incidences of IVH,BPD,ROP and assisted ventilation rate,the differences were statistically significant [9(18.7%) vs 3(5.7%),χ²=3.98,P<0.05] ;[19(39.6%) vs 10(19.2%),χ²=5.05,P<0.05];[10(20.8%) vs 2(3.8%),χ²=6.85,P<0.05];3)The incidences of NEC,fatality,oxygen therapy,time to reach full milk-feeding,etc had no statistically significant differences between two groups (P>0.05); Conclusion Efficacy of caffeine citrate in prevention and treatment of premature infant apnea and its improving the prognosis of premature infants in the near future are better than those of aminophylline,but the outcome remains need further follow-up.