以停氧为目标导向确定咖啡因治疗早产儿呼吸暂停的疗程研究  

Study on treatment course of determining caffeine for treating apnea of prematurity with oxygen discontinuation as target orientation

作　　者：王建辉[1,2] 董文辉 范颖[1,2] 冉丽红 史源[1,2] WANG Jianhui;DONG Wenhui;FAN Ying;RAN Lihong;SHI Yuan(Department of Neonatology,Affiliated Children’s Hospital of Chongqing Medical University/National Clinical Research Center for Child Health and Disorders/Ministry of Education Key Laboratory of Child Development Disease Research,Chongqing 400014,China;Chongqing Municipal Key Laboratory of Pediatric Infection and Immune Rare Diseases,Chongqing 400014,China)

机构地区：[1]重庆医科大学附属儿童医院新生儿科/国家儿童健康与疾病临床医学研究中心/儿童发育疾病研究教育部重点实验室,重庆400014 [2]儿童感染与免疫罕见病重庆市重点实验室,重庆400014

出　　处：《重庆医学》2024年第15期2334-2338,共5页Chongqing Medical Journal

基　　金：国家重点研发计划项目(2022YFC2704803);重庆市科卫联合医学科研项目(2022MSXM137);重庆医科大学未来医学青年创新团队支持计划项目(W0134)。

摘　　要：目的评估以停氧为目标导向确定咖啡因疗程的方案对氧依赖早产儿的临床受益。方法选取2021年10月至2023年9月入住该院新生儿科219例早产儿,根据随机数字法分为干预组(以停氧为目标导向咖啡因治疗,n=108)和对照组(常规咖啡因治疗,n=111)。比较两组呼吸暂停复发、重复使用咖啡因、停用咖啡因时间、用氧时间及住院时间等指标差异。结果与对照组相比,干预组停用咖啡因纠正胎龄更大[(35.9±1.7)周vs.(34.4±1.5)周],住院时间更长[(64.62±20.60)d vs.(57.96±17.68)d],差异有统计学意义(P<0.05)。两组呼吸暂停复发率、咖啡因重复使用率、用氧时间、中重度支气管肺发育不良发生率、机械通气使用率、住院费用,以及≥Ⅱ级坏死性小肠结肠炎、喂养不耐受、心动过速发生率及体重增长速度比较,差异无统计学意义(P>0.05)。结论以停氧为目标导向确定咖啡因疗程的方案不能减少早产儿的呼吸暂停复发风险及氧依赖,且有可能延长住院时间。Objective To evaluate the clinical benefit of caffeine treatment regimen determined based on oxygen discontinuation as target orientation for oxygen-dependent preterm infants.Methods A total of 219 preterm infants admitted to the neonatal department of this hospital from October 2021 to September 2023 were selected and divided into the intervention group(caffeine treatment targeting weaning oxygen,n=108)and the control group(routine caffeine treatment,n=111).The differences in the apnea recurrence,reuse of caffeine,time of caffeine discontinuation,duration of using oxygen and hospitalization duration were compared between the two groups.Results Compared with the control group,the correcting fetal age by stopping caffeine in the intervention group was greater[(35.9±1.7)weeks vs.(34.4±1.5)weeks],hospitalization duration was longer[(64.62±20.60)d vs.(57.96±17.68)d],and the differences were statistically significant(P<0.05).The apnea recurrence rate,reuse rate of caffeine,duration of oxygen use,incidence rate of moderate to severe bronchopulmonary dysplasia,mechanical ventilation use rate,hospitalization expenses,≥gradeⅡnecrotizing enterocolitis,feeding intolerance,tachycardia incidence rate and body weight increase velocity had no statistical differences between the two groups(P>0.05).Conclusion Determining the caffeine treatment course regimen by oxygen discontinuation as target orientation could not reduce the recurrent risk of preterm infants apnea recurrence risk,which could prolong the hospitalization duration.

关 键 词：早产儿呼吸暂停 咖啡因 氧依赖 住院时间 支气管肺发育不良 

分 类 号：R722.6[医药卫生—儿科]