短疗程枸橼酸咖啡因在早产儿原发性呼吸暂停中的临床效果及安全性
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摘要
目的探究短疗程枸橼酸咖啡因在早产儿原发性呼吸暂停(AOP)中的应用效果及安全性。方法选择2017年1月—2018年12月在我院治疗的102例AOP早产儿作为本次研究对象,随机分为各51例的两组,A组给予枸橼酸咖啡因治疗,B组给予氨茶碱治疗,用药后,对比两组早产儿的治疗效果、肺功能及血气指标、血浆β-内啡肽水平、不良反应发生率。结果①治疗效果及住院时间、费用:A组的呼吸暂停发作次数、严重程度、呼吸暂停消失时间,呼吸机使用率、呼吸机使用时间及住院费用优于B组(P<0.05);②肺功能及血气分析指标:用药后,A组的每分通气量、潮气量及PaO_2水平高于B组,PaCO_2水平低于B组(P<0.05);③血β-EP水平:用药后,A组的血β-EP水平低于B组及用药前(P<0.05);④不良反应发生情况:A组的不良反应发生率低于B组(P<0.05)。结论短疗程枸橼酸咖啡因能有效缓解AOP早产儿呼吸暂停症状,应用安全,故为AOP的较理想治疗方法。
Objective To explore the effect and safety of short-course caffeine citrate in the treatment of primary apnea of premature infants(AOP). Methods 102 premature AOP infants treated in our hospital from January 2017 to December 2018 were selected as the subjects of this study.They were randomly divided into two groups of 51 cases each.Group A was treated with caffeine citrate and group B with aminophylline.After treatment, the therapeutic effect, pulmonary function, blood gas index, the blood level of plasmaβ-endorphin(β-EP) and incidence of adverse reactions were compared between the two groups. Results ①The therapeutic effect,hospitalization time and cost: the frequency,severity and disappearance time of apnea,utilization rate and utility time of ventilator,and hospitalization expenses in group A were better than those in group B(P<0.05). ②Pulmonary function and blood gas analysis index: after treatment,the level of minute ventilation,tidal volume and PaO_2 in group A were higher than those in group B,and the level of PaCO _2 was lower than those in group B(P<0.05). ③The blood level of Blood β-EP: after treatment,the blood level of β-EP in group A was lower than that in group B and before treatment(P<0.05). ④Adverse reactions:the incidence of adverse reactions in group A was lower than that in group B(P<0.05). Conclusion Short course caffeine citrate may effectively alleviate the apnea symptoms of premature infants with AOP. It is safe to use and is an ideal treatment for AOP.
Objective To explore the effect and safety of short-course caffeine citrate in the treatment of primary apnea of premature infants(AOP). Methods 102 premature AOP infants treated in our hospital from January 2017 to December 2018 were selected as the subjects of this study.They were randomly divided into two groups of 51 cases each.Group A was treated with caffeine citrate and group B with aminophylline.After treatment, the therapeutic effect, pulmonary function, blood gas index, the blood level of plasmaβ-endorphin(β-EP) and incidence of adverse reactions were compared between the two groups. Results ①The therapeutic effect,hospitalization time and cost: the frequency,severity and disappearance time of apnea,utilization rate and utility time of ventilator,and hospitalization expenses in group A were better than those in group B(P<0.05). ②Pulmonary function and blood gas analysis index: after treatment,the level of minute ventilation,tidal volume and PaO_2 in group A were higher than those in group B,and the level of PaCO _2 was lower than those in group B(P<0.05). ③The blood level of Blood β-EP: after treatment,the blood level of β-EP in group A was lower than that in group B and before treatment(P<0.05). ④Adverse reactions:the incidence of adverse reactions in group A was lower than that in group B(P<0.05). Conclusion Short course caffeine citrate may effectively alleviate the apnea symptoms of premature infants with AOP. It is safe to use and is an ideal treatment for AOP.
引文
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[11] 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.
[12] 李文斌,常立文,刘伟,等.氨茶碱联合纳洛酮防治早产儿呼吸暂停与枸橼酸咖啡因疗效比较[J].中华实用儿科临床杂志,2014,29 (18):1381-1384.
[13] DOYLE L W,SCHMIDT B,ANDERSON P J,et al.Reduction in develop mental coordination disorder with neonatal caffeine therapy[J].J Pediatr,2014,165(1):356-359.
[14] 吴春艳,王晓娇,王媛媛,等.枸椽酸咖啡因对新生儿呼吸暂停血气指标的影响[J].海南医学院学报,2015,21(11):1539-1541.
[15] POETS C F,LORENZ L.Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates:current evidence[J].Arch Dis Child Fetal Neonatal Ed,2018,103(3):285-291.
[16] 纪小艺,吴敏,杨戎威,等.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停临床疗效及对血β-内啡肽的影响[J].浙江中西医结合杂志,2018,28(11):954- 957.
[2] ANCEL P Y,GOFFINET F,KUHN P,et al.Survival and morbidity of preterm children born at 22 through 34 weeks' gestation in france in 2011:results of the EPIPAGE-2 cohort study[J].JAMA Pediatr,2015,169(3):230-238.
[3] 谢士笛,张海鸿,万彬,等.动态观察枸橼酸咖啡因治疗原发性早产儿呼吸暂停的脑电活动变化[J].山东医药,2018,58(42):46- 48.
[4] 林法涛,宋燕燕,张腾伟,等.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停的疗效及其智能发育比较[J].中国新生儿科杂志,2016,31(5):325-329.
[5] 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].Neonatol,2016,109(3):221-227.
[6] 邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].北京:人民卫生出版社,2011:245-247.
[7] 李丽,周彬.高剂量与低剂量咖啡因治疗早产儿原发性呼吸暂停效果及安全性研究[J].中国全科医学,2017,20(35):4442- 4446.
[8] SáNCHEZ de la TORRE M,NADAL N,CORTIJO A,et al.Role of primary care in the follow-up of patients with obstructive sleep apnoea undergoing CPAP treatment:a randomised controlled trial[J].Thorax,2015,70(4):346-352.
[9] ROTH C,DEINSBERGER W,KLEFFMANN J,et al.Intracranial pressure and cerebral perfusion pressure during apnoea testing for the diagnosis of brain death-an observational study[J].Eur J Neurol,2015,22(8):1208-1214.
[10] 贾小红,张倩,高红霞,等.不同剂量枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效比较[J].中国医院用药评价与分析,2017,17(5):658- 660.
[11] 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.
[12] 李文斌,常立文,刘伟,等.氨茶碱联合纳洛酮防治早产儿呼吸暂停与枸橼酸咖啡因疗效比较[J].中华实用儿科临床杂志,2014,29 (18):1381-1384.
[13] DOYLE L W,SCHMIDT B,ANDERSON P J,et al.Reduction in develop mental coordination disorder with neonatal caffeine therapy[J].J Pediatr,2014,165(1):356-359.
[14] 吴春艳,王晓娇,王媛媛,等.枸椽酸咖啡因对新生儿呼吸暂停血气指标的影响[J].海南医学院学报,2015,21(11):1539-1541.
[15] POETS C F,LORENZ L.Prevention of bronchopulmonary dysplasia in extremely low gestational age neonates:current evidence[J].Arch Dis Child Fetal Neonatal Ed,2018,103(3):285-291.
[16] 纪小艺,吴敏,杨戎威,等.枸橼酸咖啡因与氨茶碱治疗早产儿原发性呼吸暂停临床疗效及对血β-内啡肽的影响[J].浙江中西医结合杂志,2018,28(11):954- 957.