Abstract: Objective To study the effect of different doses of caffeine citrate on the treatment of premature infants with primary apnea,so as to provide evidence for the appropriate use of caffeine citrate in clinical practice.Methods A total of 133 cases of premature infants diagnosed with primary apnea in the neonatal intensive care unit of the Second Hospital of Shandong University were selected from January 2015 to June 2016. Caffeine citrate was used to treat apnea,and the children were randomly divided into high-dose group (n=85) and low-dose group (n=50) according to the maintenance dose. In both groups,20 mg/(kg·d) caffeine citrate was used as the loading dose,which was maintained for 24 hours. After that,8—10 mg/(kg·d) caffeine citrate was given in the high-dose group and 5—7.9 mg /(kg·d) in the low-dose group. After 5 days of treatment,the effective rate of treatment,changes in attack frequency,changes in severity and ventilator utilization rate were compared between the two groups. Results The effective rate of treatment in high-dose group(86.0%) was significantly higher than that of low-dose group(72.0%),the average number of apnea episodes and severity of apnea were significantly lower in high-dose group(P＜0.05),while the difference on ventilator utilization rate between the two groups was not significant(P＞0.05). Also,children were divided into two groups according to their gestational age at birth,including <32 weeks and ≥32 weeks. The average number of apnea episodes and severity of apnea in high-dose group were significantly lower than those in low-dose group in the same gestational age group (P＜0.05). While there were no significant differences on apnea episodes and severity of apnea between different gestational age groups at the same dose(P＞0.05). Besides,the incidence of adverse reactions between the two groups was not significantly different either (P＞0.05). Conclusion Caffeine citrate is more effective in treating premature infants with apnea at maintenance of 8—10 mg/(kg·d ) than maintenance of 5—7.9 mg/(kg·d ),which does not increase the incidence of adverse reactions.

Key words: caffeine citrate, apnea, premature infants

摘要： 目的 比较不同剂量枸橼酸咖啡因治疗早产儿原发性呼吸暂停的疗效,以期为临床合理应用提供依据。方法 2015年1月-2016年6月选取山东大学第二医院新生儿监护病房诊断早产儿原发性呼吸暂停的患儿133例,均应用枸橼酸咖啡因治疗,根据其应用的维持量不同将患儿随机分为高剂量组(n=83)及低剂量组(n=50)。两组患儿均使用枸橼酸咖啡因20 mg/(kg·d)为负荷量,24 h后予维持量,高剂量组维持量8~10 mg/(kg·d),低剂量组维持量5~7.9 mg/(kg·d)。比较两组患儿在治疗5 d后的治疗有效率、发作次数变化、严重程度变化及呼吸机使用率。结果 高剂量组治疗有效率(86.0%)高于低剂量组(72.0%),5 d后呼吸暂停平均发作次数、呼吸暂停严重程度低于低剂量组,差异有统计学意义(P＜0.05),但两组上机率差异无统计学意义(P＞0.05)。将患儿按出生胎龄分成＜32周和≥32周,同出生胎龄组内,高剂量组患儿呼吸暂停发作次数和严重程度均低于低剂量组,差异有统计学意义(P＜0.05);同等剂量下,不同出生胎龄间呼吸暂停发作次数和严重程度比较,差异均无统计学意义(P＞0.05)。两组患儿不良反应发生率比较均无统计学意义(P＞0.05)。 结论 在任何出生胎龄下枸橼酸咖啡因治疗早产儿呼吸暂停维持量8~10 mg/(kg·d)较维持量5~7.9 mg/(kg·d)均更有效,且并不增加不良反应发生率。

关键词: 早产儿, 枸橼酸咖啡因, 呼吸暂停