氨茶碱与枸橼酸咖啡因治疗对呼吸暂停新生儿神经行为和后期神经发育的影响
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摘要
目的探讨氨茶碱、枸橼酸咖啡因两种不同治疗方案对呼吸暂停新生儿神经行为和后期神经发育的影响。方法前瞻性选取雅安市中医医院2016年3月至2017年10月期间诊治的符合相关标准的80例呼吸暂停新生儿,随机数字表法分为对照组(氨茶碱治疗)和观察组(枸橼酸咖啡因治疗),每组各40例。比较两组临床疗效;评估两组脑白质损伤(WMD)分级;采用Bayle婴幼儿发育量表测试智力发育指数(MDI)以及精神运动发育指数(PDI);比较两组药物安全性。结果治疗后观察组临床总有效率为95. 00%明显高于对照组的80. 00%(P <0. 05);观察组矫正胎龄40周的WMD分级较对照组明显轻,差异有统计学意义(P <0. 05),矫正年龄6个月后观察组MDI评分(101. 06±13. 90)分、PDI评分(102. 35±14. 98)分均较对照组(82. 17±11. 16)分、(87. 03±21. 92)分明显高,差异有统计学意义(P <0. 05);观察组不良反应总发生率15. 00%(6/40)较对照组的32. 50%(13/40)明显低(P <0. 05)。结论与氨茶碱相较,枸橼酸咖啡因在呼吸暂停新生儿治疗中的疗效更佳,对患儿后期行为神经发育有明显改善作用,可能机制与枸橼酸咖啡因可有效修复患儿脑白质损伤有关。
Objective To investigate the effects of aminophylline and caffeine citrate on neurobehavior and late neurodevelopment in apnea newborn. Methods The study subjects were from 80 apnea newborns who complied with relevant standards and were diagnosed and treated in Ya'an Traditional Chinese Medicine Hospital from March 2016 to October 2017. The random number table method was used to divide them into control group( aminophylline treatment) and observation group( caffeine citrate),40 patients in each group. The clinical efficacy of the two groups were compared,the white matter damage( WMD) grade was assessed in both groups,the mental development index( MDI) and psychomotor development index( PDI) were tested using the Bayle Infant Development Scale,the drug safety of the two groups was compared. Results After treatment,the total effective rate of the observation group was 95. 00%,significantly higher than that of the control group( 80. 00%)( P< 0. 05). The WMD grade for 40 weeks of corrective gestational age of the observation group was significantly lighter than that of the control group( P < 0. 05),the MDI [( 101. 06 ± 13. 90) points]and PDI [( 102. 35 ± 14. 98) points]scores of the observation group were significantly higher than those [( 82. 17 ± 11. 16) points and( 87. 03 ± 21. 92) points]of the control group after 6 months of age correction( P < 0. 05). The total incidence of adverse reactions in the observation group was 15. 00%( 6/40),significantly lower than that( 32. 50%,13/40) in the control group( χ2= 5. 034,P < 0. 05). Conclusion Compared with aminophylline,caffeine citrate is more effective in the treatment of apnea newborns,it can significantly improve the behavioral nerve development in children at later stage. The possible mechanism may be that caffeine caffeine can effectively repair white matter damage of children.
Objective To investigate the effects of aminophylline and caffeine citrate on neurobehavior and late neurodevelopment in apnea newborn. Methods The study subjects were from 80 apnea newborns who complied with relevant standards and were diagnosed and treated in Ya'an Traditional Chinese Medicine Hospital from March 2016 to October 2017. The random number table method was used to divide them into control group( aminophylline treatment) and observation group( caffeine citrate),40 patients in each group. The clinical efficacy of the two groups were compared,the white matter damage( WMD) grade was assessed in both groups,the mental development index( MDI) and psychomotor development index( PDI) were tested using the Bayle Infant Development Scale,the drug safety of the two groups was compared. Results After treatment,the total effective rate of the observation group was 95. 00%,significantly higher than that of the control group( 80. 00%)( P< 0. 05). The WMD grade for 40 weeks of corrective gestational age of the observation group was significantly lighter than that of the control group( P < 0. 05),the MDI [( 101. 06 ± 13. 90) points]and PDI [( 102. 35 ± 14. 98) points]scores of the observation group were significantly higher than those [( 82. 17 ± 11. 16) points and( 87. 03 ± 21. 92) points]of the control group after 6 months of age correction( P < 0. 05). The total incidence of adverse reactions in the observation group was 15. 00%( 6/40),significantly lower than that( 32. 50%,13/40) in the control group( χ2= 5. 034,P < 0. 05). Conclusion Compared with aminophylline,caffeine citrate is more effective in the treatment of apnea newborns,it can significantly improve the behavioral nerve development in children at later stage. The possible mechanism may be that caffeine caffeine can effectively repair white matter damage of children.
引文
[1]卢金淼,朱琳,李静,等.枸橼酸咖啡因在早产儿和足月新生儿中的药动学及其在呼吸暂停治疗中的应用进展[J].中国药学杂志,2017,52(21):1884-1888.
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[10]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.
[11]彭锋,邹敏珍,陈慧琼,等.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].中国急救医学,2016,36(s2):83-85.
[12]Schmidt B,Andemon PJ,Doyle LW,et al.Survival withoutdisability to age 5 years after neonatal caffeine therapy for apnea of prematurity[J].JAMA,2012,307(3):275-282.
[13]于梅,黄金华,朱蓉,等.枸橼酸咖啡因治疗对呼吸暂停早产儿早期肺功能的影响[J].中国当代儿科杂志,2016,18(3):206-210.
[14]Kraaijenga JV,Hutten GJ,de Jongh FH,et al.The effect of Caffeine on diaphrabmatic activity and tidal volume in preterm infants[J].J Pediatr,2015,167(1):70-75.
[15]郭玥馨,牛莉苹.枸橼酸咖啡因与氨茶碱联合纳洛酮治疗早产儿呼吸暂停临床效果[J].实用医学杂志,2016,32(5):819-821.
[16]Dosca EV,Ciechanski P,Roy A,et al.Methylxanthine reversal ofopioid-in-duced respiratory depression in the neonatal rat:mechanism and Iotation of action[J].Respir Physiol Neurobiol,2014,200:80-89.
[2]朱洪斌,高彩云,闫爱霞,等.nBiPAP和nCPAP治疗早产儿呼吸暂停疗效比较及对患儿肺功能和Gesell评分的影响[J].临床肺科杂志,2018,23(1):73-78.
[3]Atik A,Harding R,De MR,et al.Caffeine for apnea of prematurity:Effects on the developing brain[J].Neurotoxicology,2017,58:94-102.
[4]鲁宁杰,李伟.枸橼酸咖啡因与氨茶碱治疗呼吸暂停患儿的疗效分析[J].检验医学与临床,2017,14(3):440-442.
[5]邵肖梅,叶鸿瑁,丘小汕,等.实用新生儿学[M].4版.北京:人民卫生出版社,2012:245-247.
[6]Dobson NR,Patel RM.The role of caffeine in noninvasive respiratorysupport[J].Clin Perinatol,2016,43(4):773-782.
[7]黎念,谭毅.早产儿呼吸暂停治疗研究进展[J].中国临床新医学,2014,7(6):558-562.
[8]秦素芳.枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停临床疗效比较研究[J].儿科药学杂志,2016,32(2):28-29.
[9]吴春艳,贾晓娟,白彦红.枸橼酸咖啡因对新生儿呼吸暂停的治疗作用[J].长春中医药大学学报,2016,32(3):622-624.
[10]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.
[11]彭锋,邹敏珍,陈慧琼,等.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].中国急救医学,2016,36(s2):83-85.
[12]Schmidt B,Andemon PJ,Doyle LW,et al.Survival withoutdisability to age 5 years after neonatal caffeine therapy for apnea of prematurity[J].JAMA,2012,307(3):275-282.
[13]于梅,黄金华,朱蓉,等.枸橼酸咖啡因治疗对呼吸暂停早产儿早期肺功能的影响[J].中国当代儿科杂志,2016,18(3):206-210.
[14]Kraaijenga JV,Hutten GJ,de Jongh FH,et al.The effect of Caffeine on diaphrabmatic activity and tidal volume in preterm infants[J].J Pediatr,2015,167(1):70-75.
[15]郭玥馨,牛莉苹.枸橼酸咖啡因与氨茶碱联合纳洛酮治疗早产儿呼吸暂停临床效果[J].实用医学杂志,2016,32(5):819-821.
[16]Dosca EV,Ciechanski P,Roy A,et al.Methylxanthine reversal ofopioid-in-duced respiratory depression in the neonatal rat:mechanism and Iotation of action[J].Respir Physiol Neurobiol,2014,200:80-89.