目的 探讨高剂量与低剂量咖啡因治疗早产儿原发性呼吸暂停的临床效果和安全性.方法 选择2014年8月—2016年8月洛阳市妇女儿童医疗保健中心收治的早产儿原发性呼吸暂停患儿104例,采用随机数字表法分为对照组和观察组,每组52例.观察组给予枸橼酸咖啡因首次剂量为20 mg/kg,静脉滴注时间在30 min以上,24 h后维持15 mg/kg,1次/d,在呼吸暂停消失7 d后停药.对照组给予枸橼酸咖啡因首次剂量为20 mg/kg,静脉滴注时间在30 min以上,24 h后维持5 mg/kg,1次/d,在呼吸暂停消失7 d后停药.观察并记录两组患儿治疗效果,治疗第1天、第2天、第3天记录呼吸暂停发生次数及呼吸暂停严重程度评分,用药后可能发生的不良反应,两组呼吸机使用次数及使用时间.结果 观察组治疗效果优于对照组,差异有统计学意义(u=-2.717,P=0.007).观察组治疗第1天、第2天、第3天呼吸暂停发生次数少于对照组,呼吸暂停严重程度评分低于对照组(P<0.05).两组患儿心动过速、烦躁不安、喂养困难、高血糖症、低钾血症、总不良反应发生率比较,差异均无统计学意义(P>0.05).观察组患儿呼吸机使用率低于对照组,呼吸机使用时间短于对照组(χ2=10.636,P<0.05;t=2.232,P<0.05).结论 高剂量咖啡因治疗早产儿原发性呼吸暂停疗效优于低剂量,可减轻患儿临床症状,减少呼吸暂停发生次数,降低呼吸机使用率,值得临床推广.%Objective To investigate the clinical effect and safety of high-dose versus low-dose caffeine citrate in the treatment of primary apnea in premature infants. Methods We enrolled 104 premature infants with primary apnea who received treatment in Luoyang Women and Children′s Health Care Center from August 2014 to August 2016 and equally divided them into the control group and observation group based on the random number table. Patients in the observation group received high-dose caffeine citrate treatment:infusing caffeine citrate 20 mg/ kg for over 30 min on the first day,then changed to a maintenance dose of 15 mg/ kg after 24 h,and this treatment stopped at 7 days after the disappearance of apnea. Those in the control group received low-dose caffeine citrate treatment:infusing caffeine citrate 20 mg/ kg for over 30 min on the first day, then the dose was changed to a maintenance dose of 5 mg/ kg after 24 h,and the treatment stopped at 7 days after the disappearance of apnea. The treatment effects achieved in both groups were observed and compared. We calculated the number and evaluated the severity of apnea occurring in both groups at the 1st,2nd and 3rd days after treatment. And the incidence of adverse reactions,frequency and duration of ventilator treatment were compared between the two groups after treatment. Results The treatment effect achieved in the observation group was better than that in the control group (u =-2. 717,P = 0. 007). Less number of apnea and lower apnea severity scores were found in the observation group than in the control group at the 1st, 2nd and 3rd days after treatment (P < 0. 05). There were no significant differences in the incidence of tachycardia,dysphoria, feeding difficulties,hyperglycemia,hypokalemia,and total adverse reactions between the two groups (P > 0. 05). Compared with the control group,the observation group had lower rate of ventilator treatment (χ2 = 10. 636,P < 0. 05)and shorter duration of ventilator treatment (t = 2. 232,P < 0. 05). Conclusion For premature infants with primary apnea,by using high- dose caffeine citrate,better treatment effect can be achieved,which is mainly reflected in that the clinical symptoms can be alleviated,the frequency of apnea can be reduced,and the rate of ventilator treatment can be lowered,so the therapy is worthy of clinical promotion.
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