目的探讨小剂量氨茶碱对早产儿临床预后及脑神经发育的影响。方法选择2007年12月至2009年12月本院新生儿重症监护病房收治的日龄<14天、因呼吸暂停或便于撤离机械通气用氨茶碱治疗的极低出生体重早产儿,对于机械通气者与未机械通气治疗者进行分层分析。将机械通气患儿随机分为观察1组、观察2组和对照组,观察1组于撤机前应用氨茶碱,持续至无呼吸暂停后5天;观察2组于机械通气第1天开始应用氨茶碱,持续至校正胎龄32周;对照组不用氨茶碱。有呼吸暂停而不需机械通气者为无机械通气组,应用氨茶碱的患儿为观察组,未用氨茶碱的患儿为对照组。氨茶碱首剂4mg/kg,维持量2mg/kg,每12h一次。观察并记录住院时间、上呼吸机时间、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、脑白质软化(PVL)、坏死性小肠结肠炎(NEC)、动脉导管未闭(PDA)发生率及预后,所有生存早产儿出院后进行听力、视力、体格智力发育随访。结果 353例研究对象入选,其中6例在治疗中放弃,7例死亡(4例住院期间,3例出院后婴幼儿期死亡)。住院治疗期间,无机械通气患儿观察组住院时间短于对照组[(39.4±15.7)天比(45.2±12.1)天,P<0.05],BPD、PVL的发生率低于对照组[1.3%比9.0%,1.3%比10.3%,P<0.05];机械通气组中,观察2组与观察1组住院时间、上呼吸机治疗时间均短于对照组[(40.3±13.5)、(47.4±14.7)天比(52.3±17.6)天,(3.9±3.2)、(5.1±3.9)天比(5.9±4.3)天,P<0.05],BPD、PVL、NEC的发生率低于对照组[3.1%、9.1%比10.0%,3.1%、4.5%比10.0%,3.1%、4.5%比13.8%,P<0.05],尤其以观察2组明显。随访过程中,各组均有患儿失访,无机械通气患儿失访60例,机械通气患儿失访54例,完成随访者进行比较,无机械通气患儿脑瘫、耳聋、失明的发生率观察组与对照组比较差异无统计学意义(P>0.05),需要早期干预的患儿明显少于对照组(P<0.05)。机械通气组患儿脑瘫、耳聋、失明的发生率观察组与对照组比较差异无统计学意义(P>0.05),MDI<70、需要早期干预或进行语言训练的患儿明显减少(P<0.05)。结论应用氨茶碱治疗早产儿呼吸暂停或便于撤离呼吸机,对患儿临床预后及脑神经发育有一定改善,无明显不良反应及后遗症的发生。 Objective To investigate the effect of low dose aminophylline on the clinical prognosis and brain development in premature infants. METHODS: The neonatal intensive care unit admitted to our hospital from December 2007 to December 2009 was less than 14 days old and had minimal risk for mechanical ventilation due to apnea or withdrawal from mechanical ventilation with aminophylline, a very low birth weight preterm infants. Hierarchical analysis was performed with and without mechanical ventilation. The children with mechanical ventilation were randomly divided into observation group 1, observation group 2 and control group. Observation group 1 was given aminophylline before weaning and lasted for 5 days without apnea. Observation group 2 started on the first day of mechanical ventilation Application of aminophylline, until the correction of gestational age 32 weeks; control group without aminophylline. Patients who had apnea without mechanical ventilation had no mechanical ventilation, those with aminophylline were the observation group, and those without aminophylline were the control group. Aminophylline first dose 4mg / kg, maintenance dose 2mg / kg, once every 12h. The duration of hospital stay, ventilator time, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), leukomalacia (PVL), necrotizing enterocolitis (NEC), patent ductus arteriosus (PDA) Incidence and prognosis, all surviving preterm children were discharged after hearing, visual acuity, physical and mental development follow-up. Results 353 subjects were enrolled, 6 of whom were abandoned during treatment and 7 died (4 during hospitalization and 3 during infancy after discharge from infancy). During hospitalization, the hospitalization time of observation group was shorter than that of control group (39.4 ± 15.7 days vs 45.2 ± 12.1 days, P <0.05), and the incidence of BPD and PVL was lower than that of control group [1.3% (9.0%, 1.3% vs 10.3%, P <0.05). In the mechanical ventilation group, the length of stay in the observation group 2 and the observation group 1 were shorter than those in the control group [(40.3 ± 13.5) and (47.4 ± 14.7), and the incidence of BPD, PVL and NEC was lower than that of the control group [3.1 (3.1 ± 3.9) vs (5.9 ± 4.3) days, P <0.05] %, 9.1% vs 10.0%, 3.1%, 4.5% vs 10.0%, 3.1%, 4.5% vs 13.8%, P <0.05]. During follow-up, there were no children in each group, 60 children lost to mechanical ventilation and 54 children lost to mechanical ventilation. The children who had no mechanical ventilation had cerebral palsy, deafness and blindness There was no significant difference between the observation group and the control group (P> 0.05). The number of children who needed early intervention was significantly less than that of the control group (P <0.05). There was no significant difference in the incidence of cerebral palsy, deafness and blindness between the observation group and the control group in the mechanical ventilation group (P <0.05). The MDI <70, children with early intervention or language training were significantly decreased (P <0.05 ). Conclusion The application of aminophylline in the treatment of apnea in preterm infants or to facilitate the evacuation of ventilator has a certain improvement on clinical prognosis and brain development in children with no obvious adverse reactions and sequelae.