不同维持剂量枸橼酸咖啡因对极早产儿呼吸窘迫综合征撤机影响:前瞻性随机对照研究  

Effect of different maintenance doses of caffeine citrate on ventilator weaning in very preterm infants with respiratory distress syndrome:a prospective randomized controlled trial

作　　者：黎小兰 蔡岳鞠 张喆 李坚 陈晓文 宋燕燕 周伟 LI Xiao-Lan;CAI Yue-Ju;ZHANG Zhe;LI Jian;CHEN Xiao-Wen;SONG Yan-Yan;ZHOU Wei(Department of Child Health Care,Guangzhou Women and Children's Medical Center,Guangzhou 510623,China)

机构地区：[1]广州市妇女儿童医疗中心儿童保健部,广东广州510623 [2]广州市妇女儿童医疗中心新生儿科,广东广州510623

出　　处：《中国当代儿科杂志》2021年第11期1097-1102,共6页Chinese Journal of Contemporary Pediatrics

摘　　要：目的分析不同维持剂量枸橼酸咖啡因对胎龄≤32周极早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)撤机成功率的影响。方法前瞻性选取2016年1月至2018年12月该院收治的胎龄≤32周、需有创机械通气的162例RDS早产儿为研究对象,随机分为咖啡因高剂量组和低剂量组,每组81例。两组患儿生后6 h内均给予负荷量咖啡因20 mg/kg治疗,24 h后高、低剂量组分别给予每日10 mg/kg和5 mg/kg的咖啡因维持剂量治疗。比较两组患儿撤机后48 h内的重新插管率、总通气时间、氧疗时间、肠内喂养及体重增长情况、住院期间并发症和不良反应的发生率。结果高剂量组撤机后48 h内再插管率低于低剂量组(P<0.05),两组主要撤机失败原因均为频繁呼吸暂停。高剂量组总机械通气时间及氧疗时间均短于低剂量组(P<0.05)。两组患儿达完全肠内喂养时间、平均每天体重增长量、出院时体重及住院期间并发症(支气管肺发育不良、早产儿视网膜病、坏死性小肠结肠炎、颅内出血)和不良反应(心动过速、高血压、喂养不耐受)发生率比较差异均无统计学意义(P>0.05)。结论高维持剂量咖啡因可安全有效降低胎龄≤32周早产儿RDS撤机后呼吸暂停发生率和撤机失败率,值得临床推广应用。Objective To study the effect of different maintenance doses of caffeine citrate on the success rate of ventilator weaning in very preterm infants(gestational age of≤32 weeks)with respiratory distress syndrome(RDS).Methods A total of 162 preterm infants with RDS who were admitted to the hospital from January 2016 to December 2018 were enrolled in this prospective trial.These infants had a gestational age of≤32 weeks and required invasive mechanical ventilation.They were randomly divided into a high-dose caffeine group and a low-dose caffeine group,with 81 infants in each group.Within 6 hours after birth,both groups were given caffeine at a dose of 20 mg/kg.After 24 hours,the high-and low-dose caffeine groups were given caffeine at a maintenance dose of 10 mg/kg and 5 mg/kg,respectively.The two groups were compared in terms of re-intubation rate within 48 hours after ventilator weaning,durations of ventilation and oxygen therapy,enteral feeding,weight gain,and the incidence rates of complications and adverse reactions during hospitalization.Results The high-dose caffeine group had a significantly lower re-intubation rate within 48 hours after ventilator weaning than the low-dose caffeine group(P<0.05),with frequent apnea as the main reason for failed ventilator weaning in both groups.The high-dose caffeine group had significantly shorter durations of mechanical ventilation and oxygen therapy than the low-dose caffeine group(P<0.05).There were no significant differences between the two groups in the time to total enteral feeding,average daily weight gain,body weight at discharge,and the incidence rates of complications(bronchopulmonary dysplasia,retinopathy of prematurity,necrotizing enterocolitis,and intracranial hemorrhage)and adverse reactions(tachycardia,hypertension,and feeding intolerance)(P>0.05).Conclusions A high maintenance dose of caffeine can safely and effectively reduce the incidence rate of apnea after ventilator weaning and the failure rate of ventilator weaning in RDS preterm infants with a ges

关 键 词：呼吸窘迫综合征 枸橼酸咖啡因 撤离呼吸机 早产儿 

分 类 号：R722.6[医药卫生—儿科]