枸橼酸咖啡因不同维持剂量对呼吸窘迫综合征极早产儿呼吸机撤机的影响：一项前瞻性随机对照试验。
Effect of different maintenance doses of caffeine citrate on ventilator weaning in very preterm infants with respiratory distress syndrome: a prospective randomized controlled trial.
机构信息
Department of Child Health Care, Guangzhou Women and Children's Medical Center, Guangzhou 510623, China.
出版信息
Zhongguo Dang Dai Er Ke Za Zhi. 2021 Nov 15;23(11):1097-1102. doi: 10.7499/j.issn.1008-8830.2107167.
OBJECTIVES
To study the effect of different maintenance doses of caffeine citrate on the success rate of ventilator weaning in very preterm infants (gestational age of ≤32 weeks) with respiratory distress syndrome (RDS).
METHODS
A total of 162 preterm infants with RDS who were admitted to the hospital from January 2016 to December 2018 were enrolled in this prospective trial. These infants had a gestational age of ≤32 weeks and required invasive mechanical ventilation. They were randomly divided into a high-dose caffeine group and a low-dose caffeine group, with 81 infants in each group. Within 6 hours after birth, both groups were given caffeine at a dose of 20 mg/kg. After 24 hours, the high- and low-dose caffeine groups were given caffeine at a maintenance dose of 10 mg/kg and 5 mg/kg, respectively. The two groups were compared in terms of re-intubation rate within 48 hours after ventilator weaning, durations of ventilation and oxygen therapy, enteral feeding, weight gain, and the incidence rates of complications and adverse reactions during hospitalization.
RESULTS
The high-dose caffeine group had a significantly lower re-intubation rate within 48 hours after ventilator weaning than the low-dose caffeine group (<0.05), with frequent apnea as the main reason for failed ventilator weaning in both groups. The high-dose caffeine group had significantly shorter durations of mechanical ventilation and oxygen therapy than the low-dose caffeine group (<0.05). There were no significant differences between the two groups in the time to total enteral feeding, average daily weight gain, body weight at discharge, and the incidence rates of complications (bronchopulmonary dysplasia, retinopathy of prematurity, necrotizing enterocolitis, and intracranial hemorrhage) and adverse reactions (tachycardia, hypertension, and feeding intolerance) (>0.05).
CONCLUSIONS
A high maintenance dose of caffeine can safely and effectively reduce the incidence rate of apnea after ventilator weaning and the failure rate of ventilator weaning in RDS preterm infants with a gestational age of ≤32 weeks, and therefore, it holds promise for clinical application.
目的
研究不同剂量枸橼酸咖啡因维持治疗对胎龄≤32 周呼吸窘迫综合征（RDS）早产儿撤机成功率的影响。
方法
本前瞻性研究纳入了 2016 年 1 月至 2018 年 12 月收治的 162 例胎龄≤32 周、需要有创机械通气的 RDS 早产儿。两组患儿均于生后 6 小时内给予 20mg/kg 咖啡因负荷量，24 小时后，高、低剂量咖啡因组分别给予 10mg/kg 和 5mg/kg 维持量。比较两组患儿撤机后 48 小时内再次插管率、呼吸机使用时间、氧疗时间、开始肠内喂养时间、体质量增长情况及住院期间并发症和不良反应发生率。
结果
高剂量咖啡因组撤机后 48 小时内再次插管率显著低于低剂量咖啡因组（<0.05），两组患儿撤机失败的主要原因为频繁呼吸暂停。高剂量咖啡因组呼吸机使用时间和氧疗时间均显著短于低剂量咖啡因组（<0.05）。两组患儿开始肠内喂养时间、平均日体质量增长、出院时体质量及支气管肺发育不良、早产儿视网膜病变、坏死性小肠结肠炎、颅内出血等并发症发生率和心动过速、高血压、喂养不耐受等不良反应发生率差异均无统计学意义（>0.05）。
结论
高剂量枸橼酸咖啡因维持治疗可安全、有效地降低胎龄≤32 周 RDS 早产儿撤机后呼吸暂停发生率和撤机失败率，具有一定的临床应用前景。
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