Abstract:

Objective　To observe the efficacy and safety of high-dose caffeine citrate assisted mechanical ventilation in the treatment of premature infants with respiratory apnea (AOP). Methods　One hundred and twenty-three children with AOP treated at Nanyang Central Hospital from June 2020 to March 2023 were selected for the randomized controlled trial. The enrolled children were divided into a conventional group (61 cases) and a high-dose group (62 cases) by the random number table method. Both groups received continuous positive airway pressure ventilation; the conventional group received a conventional dose of caffeine citrate to assist ventilation; the high-dose group received the maintenance dose of 10 mg/kg caffeine citrate to assist ventilation. The treatment statuses, improvement of apnea symptoms, improvement of lung function, and treatment safety were compared between the two groups. χ² and t tests were applied. Results　The ventilation time, oxygen usage time, ICU stay time, and hospitalization time in the high-dose group were shorter than those in the conventional group [(4.25±1.33) d vs. (5.28±1.77) d, (4.02±1.47) d vs. (5.14±1.46) d, (5.12±1.36) d vs. (6.65±2.43) d, and (10.25±3.41) d vs. (14.15±5.26) d], with statistical differences (t=3.65, 4.24, 4.32, and 4.89; all P<0.05). The frequencies of apnea episodes within 24, 48, and 72 h of the treatment in the high-dose group were lower than those in the conventional group [(8.44±2.23) times vs. (9.77±2.42) times, (6.36±1.47) times vs. (7.85±2.26) times, and (3.25±0.76) times vs. (4.49±1.47) times], with statistical differences (t=3.17, 4.34, and 5.89; all P<0.05). After the treatment, the tidal volume, peak time ratio, and peak volume ratio in the high-dose group were higher than those in the conventional group [(8.62±2.41) ml/kg vs. (7.33±2.25) ml/kg, (36.77±10.61)% vs. (30.25±10.42)%, and (35.66±10.33)% vs. (29.77±10.41)%], with statistical differences (t=3.07, 3.44, and 3.15; all P<0.05). After the treatment, there was no statistical difference in the incidence of adverse events between the high-dose group and the conventional group [8.06% (5/62) vs. 6.56% (4/61); χ²=0.19; P=0.661]. Conclusions　High-dose caffeine citrate assisted mechanical ventilation in the treatment of children with AOP can effectively improve their symptoms of apnea and recovery process. Compared with the conventional maintenance dose, the high maintenance dose of caffeine citrate does not significantly increase the risk of adverse events, with high safety.

Key words:

Respiratory apnea,  , Preterm infants,  , Ventilation therapy,  , Caffeine citrate, Lung function, Safety

摘要：

目的　观察高剂量枸橼酸咖啡因辅助机械通气治疗早产儿呼吸暂停（AOP）的效果及安全性。方法　选取2020年6月至2023年3月南阳市中心医院收治的123例AOP患儿进行随机对照试验，采用随机数字表法将入组患儿分为常规组（61例）和高剂量组（62例），两组患儿均接受持续气道正压通气治疗，常规组予以5 mg/kg枸橼酸咖啡因辅助通气治疗，高剂量组予以10 mg/kg枸橼酸咖啡因维持剂量辅助通气治疗，比较两组患儿的治疗情况、呼吸暂停症状改善情况、肺功能改善情况及治疗安全性。统计学方法采用χ²检验、t检验。结果　高剂量组的通气时间、用氧时间、重症监护病房（ICU）停留时间、住院时间均低于常规组［（4.25±1.33）d比（5.28±1.77）d、（4.02±1.47）d比（5.14±1.46）d、（5.12±1.36）d比（6.65±2.43）d、（10.25±3.41）d比（14.15±5.26）d］，差异均有统计学意义（t=3.65、4.24、4.32、4.89，均P<0.05）。高剂量组治疗24 h、48 h、72 h的呼吸暂停发作频率均低于常规组［（8.44±2.23）次比（9.77±2.42）次、（6.36±1.47）次比（7.85±2.26）次、（3.25±0.76）次比（4.49±1.47）次］，差异均有统计学意义（t=3.17、4.34、5.89，均P<0.05）。治疗后，高剂量组的潮气量、达峰时间比、达峰容积比均高于常规组［（8.62±2.41）ml/kg比（7.33±2.25）ml/kg、（36.77±10.61）%比（30.25±10.42）%、（35.66±10.33）%比（29.77±10.41）%］，差异均有统计学意义（t=3.07、3.44、3.15，均P<0.05）。治疗后，高剂量组的不良事件发生率低于常规组［8.06%（5/62）比6.56%（4/61）］，差异无统计学意义（χ²=0.19，P=0.661）。结论　高剂量枸橼酸咖啡因辅助机械通气治疗AOP可在有效改善患儿呼吸暂停症状的同时加快康复进程，与常规维持剂量相比，高维持剂量下的枸橼酸咖啡因未明显增加不良事件发生风险，安全性较高。

关键词:

呼吸暂停, 早产儿, 通气治疗, 枸橼酸咖啡因, 肺功能, 安全性