咖啡因治疗及预防早产儿呼吸暂停的效果观察

发布时间：2018-08-26 15:22

【摘要】：目的:第一部分:通过对发生原发性呼吸暂停的早产儿药物治疗的临床效果、不良反应及预后的观察,探讨枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效与安全性,为早产儿呼吸暂停治疗的药物选择提供依据。第二部分:通过观察对早产极低体重儿使用枸橼酸咖啡因预防呼吸暂停的的临床效果、不良反应及预后,探讨咖啡因对早产儿呼吸暂停预防的有效性及安全性。方法:第一部分:研究对象为2014年1月~2014年12月期间天津市中心妇产科医院新生儿科收治、明确诊断为原发性呼吸暂停的早产儿82例。随机分为咖啡因治疗组及氨茶碱治疗组,咖啡因治疗组患儿给予枸橼酸咖啡因,首剂为20 mg/kg,静脉注射,24小时后予维持量5 mg/kg/d,QD,静脉注射;氨茶碱治疗组,首剂5 mg/kg静脉注射,12小时后给予维持量2 mg/kg/次,Q12H,静脉注射。两组均于呼吸暂停消失7日后停药。对两组患儿药物治疗48小时后呼吸暂停、支气管肺发育不良、动脉导管未闭、颅内出血、心动过速、喂养不耐受及高血糖的发生率及治疗期间使用n-CPAP的时长进行统计学对照分析。第二部分:研究对象为2014年1月~2014年12月期间天津市中心妇产科医院新生儿科收治的早产儿132例(排除发育畸形、败血症、先天性心脏病等因素)。随机分为咖啡因治疗组及对照组。咖啡因治疗组于生后满24小时即开始经静脉输入枸缘酸咖啡因,首剂20 mg/kg,24小时后开始给予维持量5 mg/kg,QD,直至矫正胎龄满34周。对照组不使用甲基黄嘌呤类药物。至用药48小时后对两组患儿的呼吸暂停发生率、使用呼吸机及n-CPAP的时长、心动过速的发生率、动脉导管未闭的发生率、喂养不耐受的发生率、颅内出血的发生率、支气管肺发育不良的发生率、体重增长速率及住院时长进行比较,分析其统计学差异。结果:第一部分:对82例原发性呼吸暂停的早产儿随机分组。咖啡因治疗组与氨茶碱治疗组在再次呼吸暂停发生率、使用n-CPAP时长、BPD的发生率比较,差异均无统计学意义(P0.05)。而二组患儿PDA发生率、颅内出血发生率、心动过速的发生率、高血糖的发生率及喂养不耐受的发生率比较:咖啡因治疗组均低于氨茶碱治疗组,在统计学上有明显差异(P0.05)。第二部分:对132例早产儿随机分组。比较咖啡因治疗组及对照组用药48小时后呼吸暂停发生率、住院期间使用n-CPAP时长、生后一周PDA发生率、颅内出血的发生率、住院时长,咖啡因治疗组均低于对照组,差异有统计学意义(P0.05)。而二组患儿在BPD的发生率、心动过速的发生率、喂养不耐受发生率、坏死性小肠结肠炎发生率及体重增长速率比较均无统计学差异(P0.05)。结论:1.咖啡因治疗早产儿原发性呼吸暂停治疗的疗效与氨茶碱比较无明显差异,咖啡因还具有促进动脉导管关闭及减少颅内出血的作用,且咖啡因治疗的不良反应发生率明显低于氨茶碱。故在早产儿原发性呼吸暂停的用药选择上咖啡因优于氨茶碱。2.在早产儿生后24小时即预防性给予咖啡因可有效避免原发性呼吸暂停的发生。预防性使用咖啡因还可缩短n-CPAP的使用时长,减少生后一周PDA发生率及颅内出血的发生率,缩短住院时长。且多项研究均显示咖啡因治疗无明显不良反应发生。故在早产儿生后24小时后建议给予咖啡因预防呼吸暂停,从而避免频繁发作呼吸暂停对早产儿各脏器系统的损伤,改善早产儿预后。
[Abstract]:OBJECTIVE: Part I: To investigate the efficacy and safety of caffeine citrate in the treatment of primary apnea in premature infants by observing the clinical effect, adverse reactions and prognosis of drug therapy for premature infants with primary apnea, and to provide evidence for the choice of drugs for the treatment of premature infants with apnea. Objective: To investigate the clinical effect, adverse reactions and prognosis of caffeine citrate in the prevention of apnea in very low birth weight infants, and to explore the efficacy and safety of caffeine in the prevention of apnea in premature infants. 82 premature infants with primary apnea were randomly divided into caffeine treatment group and aminophylline treatment group. The children in caffeine treatment group were given caffeine citrate, the first dose was 20 mg/kg, intravenous injection, and the maintenance dose was 5 mg/kg/d, QD, intravenous injection after 24 hours. The incidence of apnea, bronchopulmonary dysplasia, patent ductus arteriosus, intracranial hemorrhage, tachycardia, feeding intolerance and hyperglycemia, and the duration of n-CPAP use during treatment were statistically analyzed. Part: The subjects were 132 premature infants (excluding developmental malformations, sepsis, congenital heart disease and other factors) admitted to the neonatal department of Tianjin Central Obstetrics and Gynecology Hospital from January 2014 to December 2014. They were randomly divided into caffeine treatment group and control group. The control group did not use methylxanthine. The incidence of apnea, the duration of ventilator and n-CPAP, the incidence of tachycardia, patent ductus arteriosus, and feeding intolerance in the two groups were 48 hours after treatment. The incidence of intracranial hemorrhage, the incidence of bronchopulmonary dysplasia, the rate of weight gain and length of hospitalization were compared, and the statistical differences were analyzed. The incidence of PDA, intracranial hemorrhage, tachycardia, hyperglycemia and feeding intolerance were significantly lower in caffeine group than in aminophylline group (P 0.05). 132 premature infants were randomly divided into two groups. The incidence of apnea, the duration of n-CPAP, the incidence of PDA, the incidence of intracranial hemorrhage, the length of hospitalization and the duration of hospitalization were compared between the caffeine treatment group and the control group. The incidence of BPD was significantly lower in the caffeine treatment group than in the control group (P 0.05). There was no significant difference in the incidence of tachycardia, feeding intolerance, necrotizing enterocolitis and body weight gain rate (P 0.05). Conclusion: 1. There was no significant difference between caffeine and aminophylline in the treatment of primary apnea in premature infants. Caffeine is superior to aminophylline in the choice of drugs for primary apnea in premature infants. 2. Preventive administration of caffeine 24 hours after birth can effectively avoid the occurrence of primary apnea. Preventive use of caffeine can also shrink. Short-term use of n-CPAP can reduce the incidence of postnatal PDA and intracranial hemorrhage, and shorten the length of hospitalization. Many studies have shown that caffeine treatment has no obvious adverse reactions. Therefore, caffeine is recommended to prevent apnea 24 hours after birth in premature infants, so as to avoid frequent apnea attacks on the organs of premature infants. The injury of the system can improve the prognosis of premature infants.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：R722.6

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