目的 探讨枸橼酸咖啡因对原发性呼吸暂停(AOP)早产儿早期肺功能及智能发育的影响。方法 2016年1月—2017年1月选取在仙桃市第一人民医院新生儿科的160例原发性AOP早产儿,按随机数字表法分为观察组(n=80)与对照组(n=80)。对照组采用氨茶碱治疗,观察组采用枸橼酸咖啡因治疗。比较两组治疗情况及并发症发生情况,测定治疗后早期肺功能指标、血清胰岛素样生长因子结合蛋白 3(IGFBP-3)和β-内啡肽(β-EP),比较两组治疗前、校正月龄6个月和12个月时Gesell发育量表评分。结果 观察组的正压通气时间、总吸氧时间均较对照组明显缩短,且观察组治疗24、48、72 h呼吸暂停发作次数显著低于对照组(P<0.05);治疗后,两组呼吸频率(RR)、吸呼比差异无统计学意义(P>0.05),但观察组的每分钟通气量(MV)、潮气量(VT)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、潮气呼吸呼气流速(PEF)、25%/50%/75%潮气量时呼气流速(TEF25、TEF50、TEF75)均显著高于对照组(P<0.05);治疗后,观察组的血清GFBP-3显著高于对照组,β-EP显著低于对照组(P<0.05);观察组总并发症率显著低于对照组(21.25% VS. 43.75%,P<0.05);校正月龄6、12个月,观察组的Gesell评分均显著高于对照组(P<0.05)。结论 枸橼酸咖啡因辅助治疗早产儿原发性AOP能够保护患儿肺功能及神经功能,促进其智能发育,减少并发症发生。

Objectives To investigate the influence of caffeine citrate on early pulmonary function and intellectual development of premature infants with apnea of prematurity (AOP). Methods A total of 160 infants with primary AOP were enrolled in this study from January 2016 to January 2017,and were randomly divided into observation group (n=80) and control group (n=80). The control group was treated with aminophylline,while the observation group was given citrate caffeine. The treatment situation and complications were compared between the two groups. The early pulmonary function parameters,serum levels of IGFBP-3 and β-EP were measured after treatment,the Gesell Development Scale(GDS) score were compared at corrected age 6 and 12 months. Results The positive pressure ventilation time and total oxygen inhalation time in the observation group were significantly shorter than those in control group,and the apnea episodes at 24,48 and 72 hours after treatment in observation group were significantly lower than that of control group (P<0.05). After treatment,there were no significant differences on respiratory rate (RR) and respiration ratio between the two groups (P>0.05),but the minute ventilation (MV),tidal volume (VT),peak-to-peak time ratio (TPTEF/TE),peak-to-peak volume ratio (VPEF/VE),tidal breathing expiratory flow rate (PEF),tidal volume 25%,50%,75% exhalation flow rate (TEF25,TEF50,and TEF75) in observation group were significantly higher than those in control group (P<0.05). After treatment,the serum level of GFBP-3 in observation group was significantly higher than that in control group,while β-EP was significantly lower in observation group (P<0.05). The total complication rate in the observation group was significantly lower than that in control group (21.25% vs. 43.75%,P<0.05). The Gesell scores at 6,12 months of corrected age in the observation group were significantly higher than those in control group (P<0.05). Conclusion Citrate caffeine adjuvant therapy for primary AOP in premature infants can protect pulmonary function and neurological function,promote intelliectual development,and reduce complications.