| 摘要: |
| 目的：探讨枸橼酸咖啡因对改善早产儿辅助通气及早产儿呼吸暂停(AOP)的临床疗效。方法：回顾性分析2014年1月1日至2014年12月31日于我院新生儿病房住院的早产儿334例，从防治呼吸暂停和辅助通气两方面比较使用枸橼酸咖啡因、氨茶碱或氨茶碱联合纳洛酮这三种治疗方案的临床疗效，观察患儿撤机时胎龄、辅助通气时间、再插管率、呼吸暂停总体有效率、呼吸暂停频率、复发率、病死率、住院时间及各种并发症及不良反应发生情况。结果：在防治呼吸暂停方面，三组住院期间呼吸暂停发生频率比较差异有统计学意义（χ2=4.332，P<0.05)；三组总效率分别为88.6%、74.0%、75.0%（χ2=6.45，P<0.05）；复发率分别为19.0%、24.0%、47.1%（χ2=7.2，P<0.05）。在辅助通气方面，三组撤机时胎龄分别为31.7周、32.0周、32.9周（P>0.05），三组辅助通气时间比较差异无统计学意义（上四分位数分别为7.0 d、8.0 d及6.0 d，P>0.05），三组撤机后呼吸暂停发生率及再次辅助通气率比较差异无统计学意义（P>0.05）。枸橼酸咖啡因组BPD、PDA及NEC的发生率更低（P均<0.05)，各组病死率比较差异无统计学意义。结论：咖啡因可减少早产儿住院期间呼吸暂停发生频率，提高治疗总体有效率，降低呼吸暂停复发率；在辅助通气方面，咖啡因在胎龄体重更小及病情更重的情况下可以达到与其他两组相似的临床效果，推测其具有提前撤机时胎龄及降低再次辅助通气率的趋势，需进一步前瞻性临床随机对照试验证实；咖啡因可能会减少早产儿BPD、PDA及NEC的发生。 |
| 关键词: 早产儿 呼吸暂停 枸橼酸咖啡因 氨茶碱 纳洛酮 |
| DOI：doi:10.13407/j.cnki.jpp.1672-108X.2016.12.004 |
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| 基金项目: |
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| The Clinical Effect of Caffeine Citrate on Improving Assisted Ventilation Situation and Apnea of Prematurity |
| Huang Qin, Tan Tian, Yu Jialin |
| (Children’s Hospital of Chongqing Medical University, Chongqing 400014, China) |
| Abstract: |
| Objective: To investigate the effects of caffeine citrate on improving assisted ventilation situation and prevention or treatment of apnea of prematurity (AOP). Methods: Retrospective analysis on January 1, 2014 to December 31, 2014 in Children’s Hospital of Chongqing Medical University neonatal ward who used caffeine citrate, aminophyllineor aminophylline combined with naloxone. On the one hand,we compared the clinical effect of the three treatment plans for prevention or treatment AOP, on the other hand, for improving assisted ventilation situation.Observing indicators: gestational age of withdraw ventilation, ventilation time, recurrent ventilation rate, apnea treatment efficacy, apnea frequency,apnea recurrence rate, mortality, the mean hospital stay, and complications, and any adverse reactions. Results: For prophylaxis or treatment of AOP, caffeine citrate group’s total effective rate for apnea is higher (88.6%, 74.0%, 75.0%, χ2=6.45, P<0.05), recurrence rate (19.0%, 24.0%, 47.1%, χ2=7.2, P<0.05). In the aspect of assisted ventilation situation, caffeine citrate has trend of lessening gestational age of withdraw ventilation (31.7 w, 32.0 w, 32.9 w, P>0.05). There was no statistically significant difference between assisted ventilation time (upper quartile: 7 d, 8 d, 6 d, P>0.05). For caffeine citrate group, the incidence of BPD, PDA and NEC is lower (P<0.05). There is no statistically significant difference between motality. Conclusions: Caffeine citrate can reduce apnea frequency, it has higher total effective rate, lower recurrence rate.With the condition of lower weigh and smaller gestational age,three kinds of treatment plans have the similar cilinical effects on assisted ventilation, it can be speculated that caffeine citrate has the trend to lessen the gestational age when off-ventilation and lower re-assited ventilation rate .it also could reduce the incidence of premature BPD, PDA and NEC. |
| Key words: prematurity apnea caffeine citrate aminophylline naloxone |
