不同起始时间应用咖啡因对早产儿安全性及有效性的评估：一项江苏省多中心研究  

Safety and efficacy of caffeine use started at different time in preterm infants: a multicenter study in Jiangsu Province, China

作　　者：杨洋[1] 程锐[1] 吴琦[2] 乔立兴[3] 杨祖铭[4] 顾红兵[5] 李双双[5] 姜善雨[6] 刘松林[7] 蒋曙红 YANG Yang;CHENG Rui;WU Qi;QIAO Li-Xing;YANG Zu-Ming;GU Hong-Bing;LI Shuang-Shuang;JIANG Shan-Yu;LIU Song-Lin;JIANG Shu-Hong(Children’s Hospital Affiliated to Nanjing Medical University,Nanjing 210008,China)

机构地区：[1]南京医科大学附属儿童医院,江苏南京210008 [2]南京市妇幼保健院,江苏南京210011 [3]东南大学附属中大医院,江苏南京210009 [4]苏州市立医院,江苏苏州215000 [5]南通市妇幼保健院,江苏南通226000 [6]无锡市妇幼保健院,江苏无锡214002 [7]徐州市妇幼保健院,江苏徐州221003 [8]常州市妇幼保健院,江苏常州213000

出　　处：《中国当代儿科杂志》2020年第2期130-135,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的评估早产儿(胎龄≤31周)早期和晚期使用咖啡因的有效性和安全性。方法从江苏省8家医院的新生儿重症监护室中回顾性选取640例胎龄≤31周的早产儿作为研究对象,其中早期应用咖啡因510例(生后≤72 h开始应用;早期应用组),晚期应用咖啡因130例(生后>72 h开始应用;晚期应用组)。比较两组早产儿的临床资料。结果早期应用组和晚期应用组在出生体重、Apgar评分、性别、胎龄、入院年龄等方面的比较差异无统计学意义(P>0.05)。早期应用组咖啡因应用起始日龄和撤除日龄小于晚期应用组(P<0.05);早期应用组咖啡因应用时间短于晚期应用组(P<0.05)。两组之间入院时呼吸支持情况的比较差异无统计学意义(P>0.05)。早期应用组呼吸暂停发生率低于晚期应用组(P<0.05);早期应用组用氧时间和住院时间短于晚期应用组(P<0.05)。早期应用组支气管肺发育不良发生率和家庭氧疗率显著低于晚期应用组(P<0.05)。两组出院时新生儿颅内出血、脑室周围白质软化、坏死性小肠结肠炎、早产儿视网膜病变、动脉导管未闭的发生率和纠正胎龄40周时新生儿神经行为评分的比较差异均无统计学意义(P>0.05)。两组的病死率比较差异亦无统计学意义(P>0.05)。结论早产儿(胎龄≤31周)早期应用咖啡因可显著缩短咖啡因应用时间、用氧时间和住院时间,且无明显不良反应。Objective To study the efficacy and safety of caffeine used in the early(≤72 hours after birth)and late(>72 hours after birth)stage in preterm infants with a gestational age of≤31 weeks.Methods A retrospective analysis was performed for 640 preterm infants(with a gestational age of≤31 weeks)who were admitted to the neonatal intensive care unit of eight hospitals in Jiangsu Province,China.Of the 640 preterm infants,510 were given caffeine in the early stage(≤72 hours after birth;early use group)and 130 were given caffeine in the late stage(>72 hours after birth;late use group).The clinical data were compared between the two groups.Results There were no significant differences in birth weight,Apgar score,sex,gestational age,and age on admission between the two groups(P>0.05).Compared with the late use group,the early use group had a significantly younger age at the beginning and withdrawal of caffeine treatment(P<0.05)and a significantly shorter duration of caffeine treatment(P<0.05).There was no significant difference in respiratory support on admission between the two groups(P>0.05).Compared with the late use group,the early use group had significantly lower incidence rate of apnea(P<0.05)and significantly shorter oxygen supply time and length of hospital stay(P<0.05).There were no significant differences between the two groups in the incidence rates of neonatal intracranial hemorrhage,periventricular leukomalacia,necrotizing enterocolitis,retinopathy of prematurity,and patent ductus arteriosus at discharge and NBNA score at the corrected gestational age of 40 weeks(P>0.05).However,significant differences were found in the incidence of bronchopulmonary dysplasia and the rate of home oxygen therapy,but there was no significant difference in the mortality rate between the two groups(P>0.05).Conclusions Early use of caffeine can shorten the duration of caffeine treatment,oxygen supply time,and length of hospital stay,with little adverse effect,in preterm infants with a gestational age of≤31 weeks.

关 键 词：咖啡因 有效性 安全性 早产儿 

分 类 号：R722.6[医药卫生—儿科]