早期预防性应用枸橼酸咖啡因对极低出生体重儿近期并发症及肺功能的影响

杨林　杨淑铄　邢景月

【摘要】 目的：探討早期预防性应用枸橼酸咖啡因对极低出生体重儿近期并发症及肺功能的影响，并评估其安全性。方法：选取2016年8月-2017年5月郑州大学第三附属医院收治的早产儿125例。按照治疗方法不同将其分为咖啡因组62例和对照组63例。咖啡因组于生后72 h内即开始静脉应用枸橼酸咖啡因，对照组给予灭菌注射用水，有呼吸暂停时给予氨茶碱。比较两组辅助通气时长、住院时间、恢复出生体重时长及近期并发症发生率，比较患儿纠正胎龄40周时潮气呼吸肺功能（呼吸频率、TV、TPTEE/TE、VPTEE/TE、TEF25、TEF50、TEF75）。结果：咖啡因组早产儿呼吸暂停（apnea of premature，AOP）发生率、辅助通气时长均低于对照组，比较差异均有统计学意义（P<0.05）；咖啡因组TV、VPTEE/TE、TPTEE/TE、TEF25、TEF75均高于对照组，比较差异均有统计学意义（P<0.05）；两组喂养不耐受、颅内出血、坏死性小肠结肠炎（NEC）、早产儿视网膜病变（ROP）、支气管肺发育不良（BPD）的发生率、恢复出生体重时长、住院时长比较，差异均无统计学意义（P>0.05）。结论：早期预防性应用枸橼酸咖啡因可降低极低出生体重儿的AOP发生率，缩短辅助通气时长，改善潮气呼吸肺功能，且无明显不良反应发生。

【关键词】 枸橼酸咖啡因； 早产儿； 呼吸暂停； 潮气呼吸肺功能

Effects of Early Prophylactic Application of Caffeine Citrate on Short-term Complications and Pulmonary Function of Very Low Birth Weight Infant/YANG Lin，YANG Shushuo，XING Jingyue，et al.

//Medical Innovation of China，2018，15（14）：059-063

【Abstract】 Objective：To investigate the effect of early prophylactic application of caffeine citrate on short-term complications and pulmonary function of very low birth weight infant，and to evaluate its safety.Method：A total of 125 premature infants admitted to the Third Affiliated Hospital of Zhengzhou University from August 2016 to May 2017 were selected.According to different treatment methods，they were divided into 62 cases of caffeine group and 63 cases of control group.Caffeine group was given caffeine citrate intravenously within 72 h after birth，and control group was given Sterile Water for Injection，and aminophylline was given when apnea was given.The duration of assisted ventilation，length of hospitalization，recovery of birth weight，incidence of short-term complications and the children corrected the tidal breathing lung function at 40 weeks of correction of gestational age（respiratory rate，TV，TPTEE/TE，VPTEE/TE，TEF25，TEF50，TEF75） between two groups were compared.Result：The incidence of apnea of premature（AOP） and duration of assisted ventilation in caffeine group were lower than those of control group，the differences were statistically significant（P<0.05）.The levels of TV，VPTEE/TE，TPTEE/TE，TEF25 and TEF75 in caffeine group were all higher than those of control group，the differences were statistically significant（P<0.05）.The incidence of feeding intolerance，intracranial hemorrhage，necrotizing enterocolitis（NEC），retinopathy of prematurity（ROP），bronchopulmonary dysplasia（BPD），and length of hospitalization，recovery of birth weight in two groups were compared，the differences were not statistically significant（P>0.05）.Conclusion：Early prophylactic application of caffeine citrate can reduce the incidence of AOP in very low birth weight infants，shorten the duration of assisted ventilation，improve the respiratory function，and has no obvious adverse reaction.

【Key words】 Caffeine Citrate； Preterm infants； Apnea； Tidal breathing lung function

First-authors address：The Third Affiliated Hospital of Zhengzhou University，Zhengzhou 450052，China

doi：10.3969/j.issn.1674-4985.2018.14.014

随着二孩政策的实行，高龄产妇、经产妇、多胎妊娠等因素增加，早产儿的出生率也随之增加[1]。早产儿，尤其是对于小于32周的早产儿呼吸暂停（apnea of premature，AOP）发生率高达50%[2]，AOP所引起的低氧血症严重影响着早产儿近期及远期预后。目前临床上用来治疗AOP的药物主要为甲基黄嘌呤类，而其中枸橼酸咖啡因凭借其较好的安全性、可耐受性，及较长的半衰期受到新生儿医师的青睐。但关于其最佳应用时机目前仍无定论，有研究认为早期（生后0～3 d）预防性应用较晚期（生后4～10 d）更能改善早产儿预后[3-4]。……