枸橼酸咖啡因治疗早产儿呼吸暂停疗效观察
|
摘要
目的探讨枸橼酸咖啡因治疗早产儿呼吸暂停的临床效果和安全性。方法将驻马店市中心医院2016年7月至2017年6月收治的73例呼吸暂停早产儿分为对照组(n=35)和观察组(n=38)。对照组患儿给予氨茶碱治疗,观察组患儿给予枸橼酸咖啡因治疗,2组患儿均连续治疗10 d;治疗10 d后,2组中治疗无效的患儿给予氨茶碱或枸橼酸咖啡因联合经鼻持续气道正压通气(NCPAP)治疗,均连续治疗10 d。比较2组患儿的临床治疗总有效率、药物联合NCPAP治疗前及治疗2 h后血气分析指标、NCPAP使用时间、药物不良反应发生率。结果单纯药物治疗10 d后,对照组和观察组患儿临床治疗总有效率分别为31.43%(11/35)、68.42%(26/38);观察组患儿临床治疗总有效率显著高于对照组(χ~2=9.975,P<0.05)。药物联合NCPAP治疗10 d后,对照组和观察组临床治疗总有效率分别为70.83%(17/24)、100.00%(12/12);观察组患儿临床治疗总有效率显著高于对照组(χ~2=4.345,P<0.05)。药物联合NCPAP治疗前2组患儿动脉血二氧化碳分压(Pa CO)2)、酸碱度(p H)、动脉血氧分压(Pa O)2)水平比较差异无统计学意义(P>0.05);与治疗前比较,2组患儿治疗2 h后Pa CO)2降低,Pa O)2和p H升高(P<0.05)。与对照组比较,治疗2 h后观察组患儿Pa CO)2降低,Pa O)2升高(P<0.05)。观察组患儿NCPAP使用时间短于对照组(P<0.05)。对照组患儿心动过速、精神异常、喂养不耐受、电解质紊乱发生率分别为34.3%(12/35)、31.4%(11/35)、28.6%(10/35)、22.9%(8/35),观察组患儿心动过速、精神异常、喂养不耐受、电解质紊乱发生率分别为13.2%(5/38)、10.5%(4/38)、7.9%(3/38)、5.3%(2/38),观察组患儿心动过速、精神异常、喂养不耐受、电解质紊乱发生率显著低于对照组(χ~2=4.552、4.876、5.322、4.771,P<0.05)。结论枸橼酸咖啡因治疗早产儿呼吸暂停疗效确切,且不良反应少,安全性高。
Objective To investigate the clinical efficacy and safety of caffeine citrate on apnea of premature infants.Methods Seventy-three premature infants with apnea admitted to the Central Hospital of Zhumadian City from July 2016 to June 2017 were divided into control group( n = 35) and observation group( n = 38). The premature infants in the control group were treated with aminophylline,while the premature infants in the observation group were treated with caffeine citrate.The premature infants in both groups were treated with drugs for 10 days. After 10 days of treatment,the ineffective premature infants in both groups were treated with aminophylline or caffeine citrate combined with nasal continuous positive airway pressure( NCPAP) for 10 days. The total effective rate of clinical treatment,blood gas analysis index before and after treated by aminophylline or caffeine citrate combined with NCPAP,time of using NCPAP and the incidence of adverse drug reactions were compared between the two groups. Results The total effective rate in the control group and the observation group was31. 43%( 11/35) and 68. 42%( 26/38) respectively after 10 days of drug treatment alone; the total effective rate in the observation group was significantly higher than that in the control group( χ~2= 9. 975,P < 0. 05). After 10 days of treatment with drug combined with NCPAP,the total effective rate in the control group and the observation group was 70. 83%( 17/24)and 100. 00%( 12/12) respectively; the total effective rate in the observation group was significantly higher than that in the control group( χ~2= 4. 345,P < 0. 05). There was no significant difference in the partial pressure of carbon dioxide in artery( Pa CO)2),power of hydrogen( p H) and partial pressure of oxygen in artery( Pa O)2) levels between the two groups before treatment with NCPAP combined with drugs after drug treatment was ineffective( P > 0. 05). Compared with before treatment,the level of Pa CO)2 decreased,Pa O)2 and p H increased in both groups after two hours of treatment( P < 0. 05). Compared with the control group,the level of Pa CO)2 decreased and Pa O)2 increased in the observation group after two hours of treatment( P <0. 05). The time of using NCPAP in the observation group was shorter than that in the control group( P < 0. 05). The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the control group was 34. 3%( 12/35),31. 4%( 11/35),28. 6%( 10/35),22. 9%( 8/35),respectively. The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the observation group was 13. 2%( 5/38),10. 5%( 4/38),7. 9%( 3/38),5. 3%( 2/38),respectively. The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the observation group was significantly lower than that in the control group( χ~2= 4. 552、4. 876、5. 322、4. 771,P < 0. 05).Conclusion Caffeine citrate has excellent efficacy,less adverse reactions and high safety in the treatment of apnea of premature infants.
Objective To investigate the clinical efficacy and safety of caffeine citrate on apnea of premature infants.Methods Seventy-three premature infants with apnea admitted to the Central Hospital of Zhumadian City from July 2016 to June 2017 were divided into control group( n = 35) and observation group( n = 38). The premature infants in the control group were treated with aminophylline,while the premature infants in the observation group were treated with caffeine citrate.The premature infants in both groups were treated with drugs for 10 days. After 10 days of treatment,the ineffective premature infants in both groups were treated with aminophylline or caffeine citrate combined with nasal continuous positive airway pressure( NCPAP) for 10 days. The total effective rate of clinical treatment,blood gas analysis index before and after treated by aminophylline or caffeine citrate combined with NCPAP,time of using NCPAP and the incidence of adverse drug reactions were compared between the two groups. Results The total effective rate in the control group and the observation group was31. 43%( 11/35) and 68. 42%( 26/38) respectively after 10 days of drug treatment alone; the total effective rate in the observation group was significantly higher than that in the control group( χ~2= 9. 975,P < 0. 05). After 10 days of treatment with drug combined with NCPAP,the total effective rate in the control group and the observation group was 70. 83%( 17/24)and 100. 00%( 12/12) respectively; the total effective rate in the observation group was significantly higher than that in the control group( χ~2= 4. 345,P < 0. 05). There was no significant difference in the partial pressure of carbon dioxide in artery( Pa CO)2),power of hydrogen( p H) and partial pressure of oxygen in artery( Pa O)2) levels between the two groups before treatment with NCPAP combined with drugs after drug treatment was ineffective( P > 0. 05). Compared with before treatment,the level of Pa CO)2 decreased,Pa O)2 and p H increased in both groups after two hours of treatment( P < 0. 05). Compared with the control group,the level of Pa CO)2 decreased and Pa O)2 increased in the observation group after two hours of treatment( P <0. 05). The time of using NCPAP in the observation group was shorter than that in the control group( P < 0. 05). The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the control group was 34. 3%( 12/35),31. 4%( 11/35),28. 6%( 10/35),22. 9%( 8/35),respectively. The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the observation group was 13. 2%( 5/38),10. 5%( 4/38),7. 9%( 3/38),5. 3%( 2/38),respectively. The incidence of tachycardia,mental disorders,feeding intolerance and electrolyte disturbance in the observation group was significantly lower than that in the control group( χ~2= 4. 552、4. 876、5. 322、4. 771,P < 0. 05).Conclusion Caffeine citrate has excellent efficacy,less adverse reactions and high safety in the treatment of apnea of premature infants.
引文
[1]黄会芝,胡晓峰,温晓红,等.枸橼酸咖啡因与氨茶碱治疗对呼吸暂停早产儿神经发育的影响[J].中华实用儿科临床杂志,2018,33(2):147-149.
[2]MARTIN R J,WILSON C G.Apnea of prematurity[J].Compr Physiol,2012,2(4):2923-2931.
[3]廖镇宇,黄瑞文,肖艾青,等.不同胎龄及出生体质量双胎早产儿224例临床分析[J].医学临床研究,2014,31(6):1130-1132.
[4]MORIETTE G,LESCURE S,EL AYOUBI M,et al.Apnea of prematurity:what's new[J].Arch Pediatr,2001,17(2):186-190.
[5]HENDERSON-SMART D J,STEER P A.Caffeine versus theophylline for apnea in preterm infants[J].Cochrane Database Syst Rev,2010,20(1):CD000273.DOI:10.1002/14651858.CD000273.
[6]VATLACH S,ARAND J,ENGEL C,et al.Safety profile comparison between extemporaneous and a licensed preparation of caffeine citrate in preterm infants with apnea of prematurity[J].Neonatology,2014,105(2):108-111.
[7]POETS C F.Apnea of prematurity:what can observational studies tell us about pathophysiology[J].Sleep Med,2010,11(7):701-707.
[8]ROBERTSON C M,WATT M J,DINU I A.Outcomes for the extremely premature infant:what's new?And where are we going[J].Pediatr Neurol,2009,40(3):189-196.
[9]杜立中.早产儿呼吸暂停的药物治疗[J].中国实用儿科杂志,2015,30(2):88-92.
[10]SCHMIDT B,ANDERSON P J,DOYLE L W,et al.Survival without disability to age 5 years after neonatal caffeine therapy forapnea of prematurity[J].JAMA,2012,307(3):275-282.
[11]赵婧,母得志.早产儿呼吸暂停诊治进展[J].临床儿科杂志,2012,30(3):291-294.
[12]何舒婕,丁国芳.早产儿呼吸暂停的管理[J].中国新生儿科杂志,2015,30(2):155-158.
[13]FRANCART S J,ALLEN M K,STEGALL-ZANATION J.Apnea of prematurity:caffeine dose optimization[J].Pediatr Pharmacol Ther,2013,18(1):45-52.
[14]ABU-SHAWEESH J M,MARTIN R J.Neonatal apnea:what's new[J].Pediatr Pulmonol,2008,43(10):937-944.
[15]LISTA G,FABBRI L,POLACKOVA R,et al.The real-world routine use of caffeine citrate in preterm infants:a European postauthorization safety study[J].Neonatology,2016,109(3):221-227.
[16]郑伟,李旭芳,张炼,等.枸橼酸咖啡因对呼吸窘迫综合征早产儿脑和肠道氧代谢的影响[J].医药导报,2017,36(8):901-904.
[17]ABU JAWDEH E G,O'RIORDAN M,LIMRUNGSIKUL A,et al.Methyxanthine use for apnea of prematurity among an international cohort of neonatologist[J].J Neonatal Perinatal Med,2013,6(3):251-256.
[18]LOWRY J A,JARRETT R V,WASSERMAN G,et al.Theophylline toxicokinetics in premature newborns[J].Arch Pediatr Adolesc Med,2001,155(8):934-939.
[19]许景林,王瑞泉,陈冬梅.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的比较[J].中国当代儿科杂志,2014,16(11):1129-1132.
[20]DE PAOLI A G,DAVIS P G,LEMYRE B.Nasal continuous positive airway pressure versus nasal intermittent positive ventilation for preterm neonates:a systematic review and metaanalysis[J].Acta Paediatrica,2003,92(1):70-75.
[21]蒲伟丛,刘翠青.咖啡因联合无创呼吸支持治疗极低出生体重儿呼吸暂停的疗效观察[J].中国小儿急救医学,2014,21(8):497-500.
[22]要丽君,范雪爱.无创呼吸支持下枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停的疗效及收益比较[J].国际呼吸杂志,2017,37(21):1633-1637.
[2]MARTIN R J,WILSON C G.Apnea of prematurity[J].Compr Physiol,2012,2(4):2923-2931.
[3]廖镇宇,黄瑞文,肖艾青,等.不同胎龄及出生体质量双胎早产儿224例临床分析[J].医学临床研究,2014,31(6):1130-1132.
[4]MORIETTE G,LESCURE S,EL AYOUBI M,et al.Apnea of prematurity:what's new[J].Arch Pediatr,2001,17(2):186-190.
[5]HENDERSON-SMART D J,STEER P A.Caffeine versus theophylline for apnea in preterm infants[J].Cochrane Database Syst Rev,2010,20(1):CD000273.DOI:10.1002/14651858.CD000273.
[6]VATLACH S,ARAND J,ENGEL C,et al.Safety profile comparison between extemporaneous and a licensed preparation of caffeine citrate in preterm infants with apnea of prematurity[J].Neonatology,2014,105(2):108-111.
[7]POETS C F.Apnea of prematurity:what can observational studies tell us about pathophysiology[J].Sleep Med,2010,11(7):701-707.
[8]ROBERTSON C M,WATT M J,DINU I A.Outcomes for the extremely premature infant:what's new?And where are we going[J].Pediatr Neurol,2009,40(3):189-196.
[9]杜立中.早产儿呼吸暂停的药物治疗[J].中国实用儿科杂志,2015,30(2):88-92.
[10]SCHMIDT B,ANDERSON P J,DOYLE L W,et al.Survival without disability to age 5 years after neonatal caffeine therapy forapnea of prematurity[J].JAMA,2012,307(3):275-282.
[11]赵婧,母得志.早产儿呼吸暂停诊治进展[J].临床儿科杂志,2012,30(3):291-294.
[12]何舒婕,丁国芳.早产儿呼吸暂停的管理[J].中国新生儿科杂志,2015,30(2):155-158.
[13]FRANCART S J,ALLEN M K,STEGALL-ZANATION J.Apnea of prematurity:caffeine dose optimization[J].Pediatr Pharmacol Ther,2013,18(1):45-52.
[14]ABU-SHAWEESH J M,MARTIN R J.Neonatal apnea:what's new[J].Pediatr Pulmonol,2008,43(10):937-944.
[15]LISTA G,FABBRI L,POLACKOVA R,et al.The real-world routine use of caffeine citrate in preterm infants:a European postauthorization safety study[J].Neonatology,2016,109(3):221-227.
[16]郑伟,李旭芳,张炼,等.枸橼酸咖啡因对呼吸窘迫综合征早产儿脑和肠道氧代谢的影响[J].医药导报,2017,36(8):901-904.
[17]ABU JAWDEH E G,O'RIORDAN M,LIMRUNGSIKUL A,et al.Methyxanthine use for apnea of prematurity among an international cohort of neonatologist[J].J Neonatal Perinatal Med,2013,6(3):251-256.
[18]LOWRY J A,JARRETT R V,WASSERMAN G,et al.Theophylline toxicokinetics in premature newborns[J].Arch Pediatr Adolesc Med,2001,155(8):934-939.
[19]许景林,王瑞泉,陈冬梅.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的比较[J].中国当代儿科杂志,2014,16(11):1129-1132.
[20]DE PAOLI A G,DAVIS P G,LEMYRE B.Nasal continuous positive airway pressure versus nasal intermittent positive ventilation for preterm neonates:a systematic review and metaanalysis[J].Acta Paediatrica,2003,92(1):70-75.
[21]蒲伟丛,刘翠青.咖啡因联合无创呼吸支持治疗极低出生体重儿呼吸暂停的疗效观察[J].中国小儿急救医学,2014,21(8):497-500.
[22]要丽君,范雪爱.无创呼吸支持下枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停的疗效及收益比较[J].国际呼吸杂志,2017,37(21):1633-1637.