Yao Ling-Song, Lin Xin-Zhu, Huang Jing, Tang Li-Xia
Department of Neonatology, Women and Children's Hospital, School of Medcine, Xiamen University/Xiamen Key Laboratory of Perinatal-Neonatal Infection, Xiamen, Fujian 361003, China.
Zhongguo Dang Dai Er Ke Za Zhi. 2021 Jan;23(1):31-36. doi: 10.7499/j.issn.1008-8830.2008044.
To study the clinical effect of an additional maintenance dose (5 mg/kg) of caffeine citrate injection at 1 hour before ventilator weaning in improving the success rate of ventilator weaning in preterm infants (gestational age ≤32 weeks) with respiratory distress syndrome (RDS) on mechanical ventilation.
A total of 338 preterm infants with RDS (gestational age of ≤32 weeks) who were admitted to the Neonatal Intensive Care Unit of Xiamen Maternal and Child Health Hospital from January 2017 to December 2019 and treated with mechanical ventilation were enrolled. They were randomly divided into an observation group and a routine group, with 169 infants in each group. Both groups received early routine treatment with caffeine. The infants in the observation group received an additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning. The two groups were compared in terms of reintubation rate and number of apnea episodes within 48 hours after ventilator weaning, changes in blood gas parameters, blood glucose, heart rate, and mean blood pressure at 2 hours after ventilator weaning, and incidence rates of major complications during hospitalization.
Compared with the routine group, the observation group had significantly lower reintubation rate (=0.034) and number of apnea episodes (≥2 times/day) (=0.015) within 48 hours after ventilator weaning. Compared with the routine group at 2 hours after ventilator weaning, the observation group had a significantly higher pH value and a significantly lower arterial partial pressure of carbon dioxide ( < 0.05), while there were no significant differences between the two groups in arterial partial pressure of oxygen, blood glucose, heart rate, and mean blood pressure ( > 0.05). During hospitalization, the observation group had a significantly lower incidence rate of intraventricular hemorrhage than the routine group (=0.048), but there were no significant differences between the two groups in the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, and periventricular leukomalacia and mortality rate ( > 0.05).
An additional maintenance dose of caffeine citrate injection at 1 hour before ventilator weaning is safe and effective in improving the success rate of ventilator weaning in preterm infants with RDS and thus holds promise for clinical application.
研究在撤机前1小时额外给予柠檬酸咖啡因注射液维持剂量（5mg/kg）对改善呼吸窘迫综合征（RDS）并接受机械通气的孕周≤32周早产儿撤机成功率的临床效果。
选取2017年1月至2019年12月在厦门市妇幼保健院新生儿重症监护病房收治的338例RDS孕周≤32周的早产儿，均接受机械通气治疗。将其随机分为观察组和常规组，每组169例。两组均早期常规给予咖啡因治疗。观察组在撤机前1小时额外给予柠檬酸咖啡因注射液维持剂量。比较两组撤机后48小时内的再插管率和呼吸暂停发作次数、撤机后2小时血气参数、血糖、心率及平均血压变化，以及住院期间主要并发症发生率。
与常规组相比，观察组撤机后48小时内再插管率（=0.034）和呼吸暂停发作次数（≥2次/天）（=0.015）显著降低。撤机后2小时，观察组pH值显著高于常规组，动脉血二氧化碳分压显著低于常规组（<0.05），而两组动脉血氧分压、血糖、心率及平均血压差异无统计学意义（>0.05）。住院期间，观察组脑室内出血发生率显著低于常规组（=0.048），但两组支气管肺发育不良、坏死性小肠结肠炎、早产儿视网膜病变、脑室周围白质软化症发生率及死亡率差异无统计学意义（>0.05）。
撤机前1小时额外给予柠檬酸咖啡因注射液维持剂量对提高RDS早产儿撤机成功率安全有效，具有临床应用前景。
