本文選題：枸櫞酸咖啡因 + 早期給藥��； 參考：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景枸櫞酸咖啡因被譽(yù)為新生兒學(xué)科的“銀子彈”,隨著在臨床中的推廣,其初始給藥時(shí)間越來越早。枸櫞酸咖啡因可顯著降低極低出生體重兒輔助通氣時(shí)間,但在不同初始給藥時(shí)間下對(duì)輔助通氣的影響仍有待評(píng)估。目的:探討早期枸櫞酸咖啡因治療對(duì)改善極低出生體重兒輔助通氣及臨床結(jié)局的效果。方法回顧性分析2015年1月1日至2016年12月31日期間于我院新生兒科病房出院的經(jīng)枸櫞酸咖啡因治療的極低出生體重兒225例,根據(jù)初始給藥時(shí)間分為早給藥組(初始給藥時(shí)間小于生后3天)和晚給藥組(初始給藥時(shí)間≥3天),觀察兩組患兒輔助通氣的時(shí)間、撤機(jī)時(shí)胎齡、撤機(jī)后的再次輔助通氣發(fā)生率、住院時(shí)間、總住院費(fèi)用、死亡率、各種并發(fā)癥及不良反應(yīng)的發(fā)生率。結(jié)果兩組患兒的一般情況、疾病譜無明顯差異(P0.05),在輔助通氣方面,早給藥組有創(chuàng)通氣時(shí)間明顯短于晚給藥組(4天vs 8天,P0.05),早給藥組在無創(chuàng)通氣時(shí)間、輔助通氣總時(shí)間均較晚給藥組短,撤機(jī)時(shí)胎齡較晚給藥組小,但差異尚無統(tǒng)計(jì)學(xué)意義(P0.05)。在臨床結(jié)局和不良反應(yīng)方面,早給藥組支氣管肺發(fā)育不良(BPD)、壞死性小腸結(jié)腸炎(NEC)及嚴(yán)重腦室內(nèi)出血(IVH)的發(fā)生率均較晚給藥組低,雖然死亡率較晚用組稍高,但以上差異并無統(tǒng)計(jì)學(xué)意義。在體重大于1250g的極低出生體重兒中,早給藥組的有創(chuàng)通氣時(shí)間、無創(chuàng)正壓通氣時(shí)間、嚴(yán)重IVH發(fā)生率均低于晚給藥組(P0.05)。結(jié)論通過本研究表明,早期枸櫞酸咖啡因的治療可顯著縮短極低出生體重兒的有創(chuàng)通氣時(shí)間,有縮短無創(chuàng)正壓通氣時(shí)間、降低極低出生體重兒發(fā)生嚴(yán)重IVH、中重度BPD、NEC發(fā)生率的趨勢(shì);對(duì)于死亡率的影響還需大樣本的研究進(jìn)一步探討。
[Abstract]:Background caffeine citrate is known as the "silver bullet" in neonatal science. Caffeine citrate can significantly reduce the duration of assisted ventilation in very low birth weight infants, but the effect of different initial administration time on auxiliary ventilation needs to be evaluated. Objective: to investigate the effect of early caffeine citrate therapy on the improvement of assisted ventilation and clinical outcome of very low birth weight infants. Methods 225 cases of very low birth weight infants treated with citrate caffeine between January 1, 2015 and December 31, 2016 were retrospectively analyzed. According to the initial administration time, they were divided into early administration group (initial administration time less than 3 days after birth) and late administration group (initial administration time 鈮，

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