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。
Abstract
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.
关键词
枸橼酸咖啡因 /
预防 /
治疗 /
原发性呼吸暂停 /
早产儿
Key words
caffeine citrate /
prevention /
treatment /
primary apnea /
premature infants
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参考文献
[1] Kreutzer K, Bassler D.Caffeine for apnea of prematurity:a neonatal successstory[J].Neonatology,2014,105(4):332-336.
[2] Martin RJ, Wilson CG.Apnea of prematurity[J].Compr Physiol, 2012,2 (4):2923-2931.
[3] Parikka V, Beck J, Zhai Q, et al.The effect of caffeine citrate on neural breathing pattern in preterm infants[J].Early HuDev,2015,91(10):565-568.
[4] Schmidt B, Roberts RS, Davis P,et al.Caffeine therapy for apnea of prematurity[J].N Engl J Med,2006,354(20):2112-2121.
[5] Davis PG, Schmidt B,Roberts RS,et al.Caffeine for apnea of prematurity trial:benefits may vary in subgroups[J].J Pediatr,2010,156(3):382-387.
[6] 柯华,李占魁,郭金珍,等.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停疗效及并发症的研究[J].中国小儿急救医学,2017,24(1):56-59.
[7] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:245-247,416-422,477-483,706-715,887-892.
[8] MorietteG,Lescure S,EI Ayoubi M,et al.Apnea of prematurity:what′s new[J].Arch Pediatr,2010,17(2):186-190.
[9] Dobson NR, Patel RM.The role of caffeine in noninvasive respiratory support[J].Clin Perinatol,2016,43(4):773-782.
[10] Yu T, Balch AH, Ward RM,etal.Incorporating pharmacodynamic considerations into caffeine therapeutic drug monitoring in preterm neonates[J].BMC Pharmacol Toxicol,2016,17(1):22.
[11] Armanian AM, Iranpour R, Faghihian E,et al.Caffeine administration to prevent apnea in very premature infants[J].Pediatr Neonatol,2016 57(5):408-412
[12] Mohr MA, Vergales BD, Lee H, et al.Very long apnea events in preterm infants[J].J Appl Physiol,2015,118(5):558-568.
[13] Ferguson KN, Roberts CT, Manley BJ,et al.Interventions to improve rates of successful extubation in preterm infants:a systematic review and meta-analysis[J].JAMA Pediatr,2017,171(2):165-174.
[14] Abdel-Hady H, Nasef N, Shabaan AE,et al.Caffeine therapy in preterm infants[J].Word J Clin Pediatr,2015,4(4):81-93.
[15] Cox C, Hashem NG, Tebbs J,et al.Evaluation of caffeine and the development of necrotizing enterocolitis[J].J Neonatal Perinatal Med,2015,8(4):339-347.
[16] Atik A, Harding R, De Matteo R,et al.Caffeine for apnea of prematurity:effects on the developing brain[J].Neurotoxicology,2017,58:94-102.
[17] Park HW, Lim G, Chung SH,et al.Early caffeine use in very low birth weight infants and neonatal outcomes:a systematic review and meta-analysis[J].J Korean Med Sci,2015,30(12):1828-1835.
[18] 余仁强,姜善雨,周勤.枸橼酸咖啡因防止早产儿呼吸暂停的研究新进展[J].中国儿童保健杂志,2016,24(8):832-834.
[19] Abdel-Wahed MA, Issa HM, Khafagy SM, et al.Effect of caffeine on superior mesenteric artery blood flow velocities in preterm neonates[J].J Matern Fetal Neonatal Med.2017,9(22):1-5.
基金
吴阶平医学基金会(320.6750.14175)
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