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目的分析不同剂量枸橼酸咖啡因和氨茶碱治疗早产儿呼吸暂停的疗效及安全性。方法选择2013年10月至2015年10月本院新生儿重症监护病房(NICU)收治的呼吸暂停早产儿,随机分为大剂量咖啡因组:负荷量40 mg/(kg·d),维持量20 mg/(kg·d),Qd;小剂量咖啡因组:负荷量20 mg/(kg·d),维持量10 mg/(kg·d),Qd;氨茶碱组:负荷量5 mg/kg,维持量2 mg/kg,Q 12 h(持续给药至呼吸暂停停止7天或纠正胎龄34周)。观察患儿拔管失败率、呼吸暂停发生率、呼吸暂停持续时间、机械通气时间、氧疗时间、住院时间、治疗过程中的不良反应、并发症发生率及死亡率。结果大剂量咖啡因组拔管失败率、呼吸暂停发生率、呼吸暂停持续时间、氧疗时间等均低于小剂量咖啡因组和氨茶碱组,心动过速发生率高于小剂量咖啡因组和氨茶碱组,差异均有统计学意义(P<0.05)。小剂量咖啡因组与氨茶碱组各项指标比较,差异无统计学意义(P>0.05)。各组机械通气时间、持续气道正压通气(CPAP)时间、住院时间及并发症发生率、死亡率等差异无统计学意义(P>0.05)。结论大剂量咖啡因可降低拔管失败率和呼吸暂停发生率,减少呼吸暂停持续时间和氧疗持续时间,除心动过速外,未增加其他不良反应。
Objective To analyze the efficacy and safety of different doses of citrate caffeine and aminophylline in the treatment of apnea in preterm infants. Methods Preterm infants with apnea admitted to neonatal intensive care unit (NICU) in our hospital from October 2013 to October 2015 were randomly divided into high-dose caffeine group: loading 40 mg / (kg · d), maintenance dose 20 mg / (kg · d), Qd; low-dose caffeine group: 20 mg / (kg · d) / kg, maintenance dose 2 mg / kg, Q 12 h (continuous dosing until apnea stopped for 7 days or corrected gestational age 34 weeks). The failure rate of extubation, the incidence of apnea, the duration of apnea, the duration of mechanical ventilation, the duration of oxygen therapy, the duration of hospitalization, the adverse reactions in the course of treatment, the incidence of complications and the mortality rate were observed. Results The failure rate of extubation, the incidence of apnea, the duration of apnea and the duration of oxygen therapy in high-dose caffeine group were lower than those in low-dose caffeine group and aminophylline group, and the incidence of tachycardia was higher than that of low-dose caffeine Group and aminophylline group, the difference was statistically significant (P <0.05). There was no significant difference between the low-dose caffeine group and aminophylline group (P> 0.05). There was no significant difference in the duration of mechanical ventilation, continuous positive airway pressure (CPAP), length of hospital stay, complication rate and mortality between the two groups (P> 0.05). Conclusion High-dose caffeine can reduce the failure rate of extubation and apnea incidence, reduce the duration of apnea and duration of oxygen therapy, in addition to the addition of tachycardia, did not increase other adverse reactions.