枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停的Meta分析

发布时间：2018-09-17 20:18

【摘要】：目的早产儿呼吸暂停是目前新生儿重症监护中面临的主要临床问题之一,若不能妥善治疗将引起一系列非常严重的并发症。国外文献指出与氨茶碱相比,枸橼酸咖啡因治疗早产儿呼吸暂停所具有治疗窗更宽、吸收更加可靠与半衰期更长的优势。国内自2013年引入枸橼酸咖啡因,目前还没有足够的证据支持其治疗效果,本文的目的就是以Meta分析的方式比较枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停的临床疗效。方法对Pub Med、Embase、Cochrane registry of controlled clinical trials、Sinomed、CNKI、Wan Fang Data以及CQVIP等数据库进行系统检索2016年3月31日以前的所有对比枸橼酸咖啡因与氨茶碱治疗早产儿呼吸暂停临床疗效的随机对照试验研究,文章语言设置为中文与英文,采用改良Jadad量表评价文献质量并提取数据进行Meta分析。结果本篇Meta分析共纳入26篇相关研究的文章,早产儿呼吸暂停采用枸橼酸咖啡因进行治疗1~3 d的有效率明显高于氨茶碱(86.33%vs.64.92%,RR=1.33,P0.000 01),采用治疗1~3 d呼吸暂停次数进行比较两者并无显著差异(MD=-0.01,P=0.83)。氨茶碱治疗的早产儿不良反应发生率明显高于枸橼酸咖啡因治疗的患儿(36.75%vs.11.30%,RR=0.32,P0.000 01),尤其是心动过速(RR=0.20,P0.000 01)、喂养不耐受(RR=0.34,P0.000 01)、烦躁激惹(RR=0.35,P=0.000 1)、高血糖(RR=0.24,P0.000 1)及血压升高(RR=0.16,P=0.03)的发生率明显高于枸橼酸咖啡因治疗组患儿。结论目前研究结果表明,枸橼酸咖啡因治疗早产儿呼吸暂停有效率高且副作用小,因而更适宜用于早产儿呼吸暂停的治疗,值得临床推广。
[Abstract]:Objective apnea of premature infants is one of the main clinical problems in neonatal intensive care at present. If not properly treated, it will cause a series of very serious complications. Compared with aminophylline, caffeine citrate has the advantages of wider therapeutic window, more reliable absorption and longer half-life compared with aminophylline in the treatment of apnea in premature infants. Since the introduction of caffeine citrate in China in 2013, there is not enough evidence to support its therapeutic effect. The purpose of this paper is to compare the clinical efficacy of caffeine citrate and aminophylline in the treatment of apnea in premature infants by Meta analysis. Methods A randomized controlled trial was conducted to systematically search the databases of Pub Med,Embase,Cochrane registry of controlled clinical trials,Sinomed,CNKI,Wan Fang Data and CQVIP for comparing the clinical efficacy of caffeine citrate and aminophylline in the treatment of apnea in premature infants before March 31, 2016. The Chinese and English languages were used to evaluate the literature quality by using the modified Jadad scale and to extract the data for Meta analysis. Results this Meta analysis included 26 articles related to the study, The effective rate of apnea in premature infants treated with caffeine citrate for 1 to 3 days was significantly higher than that of aminophylline (86.33vs.64.92rRRRRRR1.33 P0.00001). There was no significant difference in apnea times between the two groups (MD=-0.01,P=0.83). The incidence of adverse reactions in premature infants treated with aminophylline was significantly higher than that in infants treated with caffeine citrate (36.75 vs 11.30), especially in patients with RR=0.20,P0.000 01, RR=0.34,P0.000 01, RR=0.35,P=0.000 1, RR=0.24,P0.000 1 and high blood pressure (RR=0.16,P=0.03). It was significantly higher than that of caffeine citrate treatment group. Conclusion the results show that caffeine citrate is more effective and has less side effects in the treatment of apnea in premature infants, so it is more suitable for the treatment of apnea in premature infants and is worth popularizing in clinic.
【作者单位】： 山西医科大学;山西省儿童医院新生儿科;南方医科大学;
【分类号】：R722.6
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本文编号：2246980