广西医学

目的探讨不同时机预防性应用枸橼酸咖啡因对极低出生体重（VLBW）早产儿的影响。方法选择150例VLBW早产儿作为研究对象，采用随机数字表法将其分为早期组、中期组及晚期组，每组50例，分别以日龄≤24 h、24 h<日龄≤3 d、3 d<日龄≤7 d 作为首次应用枸橼酸咖啡因的时机。3组均先给予枸橼酸咖啡因负荷剂量20 mg/kg，应用24 h后给予维持剂量7 mg/（kg·d）。比较3组患儿住院期间治疗情况［首次应用枸橼酸咖啡因时间、应用枸橼酸咖啡因24 h后发生呼吸暂停情况、气管插管情况、有创呼吸机使用时间、无创呼吸机使用时间、吸氧时间、应用肺表面活性物质情况、出生至开始全肠内喂养时间、出院时矫正胎龄、出院时体重、住院时间、住院费用］、住院期间并发症［败血症、颅内出血、坏死性小肠结肠炎（NEC）、支气管肺发育不良（BPD）、呼吸机相关性肺炎、动脉导管未闭、早产儿视网膜病（ROP）］及与枸橼酸咖啡因相关不良反应（心动过速、贫血、高血糖、低钙血症等）发生情况。结果（1）首次应用枸橼酸咖啡因时间早期组<中期组<晚期组，早期组应用枸橼酸咖啡因24 h后呼吸暂停发生率、有创呼吸机使用时间、出生至开始全肠内喂养时间、出院时矫正胎龄、住院时间、住院费用低于或短于或小于中期组和晚期组（P<0.05）。（2）早期组Ⅱ级以上颅内出血、NEC、Ⅱ期以上NEC、BPD及ROP发生率低于晚期组（P<0.05）。结论早期应用枸橼酸咖啡因可减少VLBW早产儿呼吸暂停发生率和有创呼吸机应用时间，促进患儿提前脱离呼吸机，降低并发症的发生风险，使患儿更早开始全肠道内喂养，缩短住院时间，减小出院时矫正胎龄，降低医疗费用，且安全性良好。

Objective To investigate the effect of prophylactic administration of caffeine citrate at different times on very low birth weight (VLBW) preterm infants. Methods A total of 150 VLBW preterm infants were selected as the research subjects, and they were divided into early⁃stage group, middle⁃stage group, or advanced⁃stage group by the random number table method, with 50 cases in each group, with the first administration time of caffeine citrate taken as days of age ≤24 hours, 24 hours < days of age ≤3 days, and 3 days < days of age ≤7 days, respectively. All the three groups were administrated a loading dose of 20 mg/kg caffeine citrate and a maintenance dose of 7 mg/(kg·d) after 24 hours administration. Comparison of three groups of hospitalized infants regarding treatment during hospitalization in terms of time of first administration of caffeine citrate, occurrence of apnea 24 hours after caffeine citrate administration, endotracheal intubation, duration of invasive mechanical ventilation, duration of non⁃invasive mechanical ventilation, oxygen inhalation duration, use of pulmonary surfactant, time from birth to achieving full enteral feeding, corrected gestational age at discharge, weight at discharge, length of hospital stay, hospitalization costs, complications during hospitalization (sepsis, intracranial hemorrhage, necrotizing enterocolitis［NEC］, bronchopulmonary dysplasia［BPD］, ventilator associated pneumonia, patent ductus arteriosus, retinopathy of prematurity ［ROP］), and the occurrence of adverse reactions related to caffeine citrate (tachycardia, anemia, hyperglycemia, hypocalcemia, etc.). Results (1) The time of first administration of caffeine citrate was earliest in the early⁃stage group, followed by the middle⁃stage group, and latest in the advanced⁃stage group. The early⁃stage group had a lower incidence rate of apnea 24 hours after caffeine citrate administration, shorter duration of invasive mechanical ventilation, shorter time from birth to achieving full enteral feeding, younger corrected gestational age at discharge, shorter length of hospital stay, and less hospitalization costs compared to the middle⁃stage and advanced⁃stage groups (P<0.05). (2) The early⁃stage group had lower incidence rates of intracranial hemorrhage (grade more than Ⅱ), NEC, NEC (stage more than Ⅱ), BPD, and ROP compared to the advanced⁃stage group (P<0.05). Conclusion Early administration of citrate caffeine may reduce the incidence rate of apnea and duration of invasive ventilator use in VLBW preterm infants, facilitate the early weaning of ventilators for children, decrease the occurrence risk of complications, achieve full enteral feeding earlier, shorten hospital stay, reduce the corrected gestational age at discharge and hospitalization costs, exerting a favorable safety.

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