【摘要】：目的:第一部分:通過對發(fā)生原發(fā)性呼吸暫停的早產(chǎn)兒藥物治療的臨床效果、不良反應(yīng)及預(yù)后的觀察,探討枸櫞酸咖啡因治療早產(chǎn)兒原發(fā)性呼吸暫停的療效與安全性,為早產(chǎn)兒呼吸暫停治療的藥物選擇提供依據(jù)。第二部分:通過觀察對早產(chǎn)極低體重兒使用枸櫞酸咖啡因預(yù)防呼吸暫停的的臨床效果、不良反應(yīng)及預(yù)后,探討咖啡因?qū)υ绠a(chǎn)兒呼吸暫停預(yù)防的有效性及安全性。方法:第一部分:研究對象為2014年1月~2014年12月期間天津市中心婦產(chǎn)科醫(yī)院新生兒科收治、明確診斷為原發(fā)性呼吸暫停的早產(chǎn)兒82例。隨機(jī)分為咖啡因治療組及氨茶堿治療組,咖啡因治療組患兒給予枸櫞酸咖啡因,首劑為20 mg/kg,靜脈注射,24小時后予維持量5 mg/kg/d,QD,靜脈注射;氨茶堿治療組,首劑5 mg/kg靜脈注射,12小時后給予維持量2 mg/kg/次,Q12H,靜脈注射。兩組均于呼吸暫停消失7日后停藥。對兩組患兒藥物治療48小時后呼吸暫停、支氣管肺發(fā)育不良、動脈導(dǎo)管未閉、顱內(nèi)出血、心動過速、喂養(yǎng)不耐受及高血糖的發(fā)生率及治療期間使用n-CPAP的時長進(jìn)行統(tǒng)計學(xué)對照分析。第二部分:研究對象為2014年1月~2014年12月期間天津市中心婦產(chǎn)科醫(yī)院新生兒科收治的早產(chǎn)兒132例(排除發(fā)育畸形、敗血癥、先天性心臟病等因素)。隨機(jī)分為咖啡因治療組及對照組�？Х纫蛑委熃M于生后滿24小時即開始經(jīng)靜脈輸入枸緣酸咖啡因,首劑20 mg/kg,24小時后開始給予維持量5 mg/kg,QD,直至矯正胎齡滿34周。對照組不使用甲基黃嘌呤類藥物。至用藥48小時后對兩組患兒的呼吸暫停發(fā)生率、使用呼吸機(jī)及n-CPAP的時長、心動過速的發(fā)生率、動脈導(dǎo)管未閉的發(fā)生率、喂養(yǎng)不耐受的發(fā)生率、顱內(nèi)出血的發(fā)生率、支氣管肺發(fā)育不良的發(fā)生率、體重增長速率及住院時長進(jìn)行比較,分析其統(tǒng)計學(xué)差異。結(jié)果:第一部分:對82例原發(fā)性呼吸暫停的早產(chǎn)兒隨機(jī)分組�？Х纫蛑委熃M與氨茶堿治療組在再次呼吸暫停發(fā)生率、使用n-CPAP時長、BPD的發(fā)生率比較,差異均無統(tǒng)計學(xué)意義(P0.05)。而二組患兒PDA發(fā)生率、顱內(nèi)出血發(fā)生率、心動過速的發(fā)生率、高血糖的發(fā)生率及喂養(yǎng)不耐受的發(fā)生率比較:咖啡因治療組均低于氨茶堿治療組,在統(tǒng)計學(xué)上有明顯差異(P0.05)。第二部分:對132例早產(chǎn)兒隨機(jī)分組。比較咖啡因治療組及對照組用藥48小時后呼吸暫停發(fā)生率、住院期間使用n-CPAP時長、生后一周PDA發(fā)生率、顱內(nèi)出血的發(fā)生率、住院時長,咖啡因治療組均低于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。而二組患兒在BPD的發(fā)生率、心動過速的發(fā)生率、喂養(yǎng)不耐受發(fā)生率、壞死性小腸結(jié)腸炎發(fā)生率及體重增長速率比較均無統(tǒng)計學(xué)差異(P0.05)。結(jié)論:1.咖啡因治療早產(chǎn)兒原發(fā)性呼吸暫停治療的療效與氨茶堿比較無明顯差異,咖啡因還具有促進(jìn)動脈導(dǎo)管關(guān)閉及減少顱內(nèi)出血的作用,且咖啡因治療的不良反應(yīng)發(fā)生率明顯低于氨茶堿。故在早產(chǎn)兒原發(fā)性呼吸暫停的用藥選擇上咖啡因優(yōu)于氨茶堿。2.在早產(chǎn)兒生后24小時即預(yù)防性給予咖啡因可有效避免原發(fā)性呼吸暫停的發(fā)生。預(yù)防性使用咖啡因還可縮短n-CPAP的使用時長,減少生后一周PDA發(fā)生率及顱內(nèi)出血的發(fā)生率,縮短住院時長。且多項研究均顯示咖啡因治療無明顯不良反應(yīng)發(fā)生。故在早產(chǎn)兒生后24小時后建議給予咖啡因預(yù)防呼吸暫停,從而避免頻繁發(fā)作呼吸暫停對早產(chǎn)兒各臟器系統(tǒng)的損傷,改善早產(chǎn)兒預(yù)后。
[Abstract]:OBJECTIVE: Part I: To investigate the efficacy and safety of caffeine citrate in the treatment of primary apnea in premature infants by observing the clinical effect, adverse reactions and prognosis of drug therapy for premature infants with primary apnea, and to provide evidence for the choice of drugs for the treatment of premature infants with apnea. Objective: To investigate the clinical effect, adverse reactions and prognosis of caffeine citrate in the prevention of apnea in very low birth weight infants, and to explore the efficacy and safety of caffeine in the prevention of apnea in premature infants. 82 premature infants with primary apnea were randomly divided into caffeine treatment group and aminophylline treatment group. The children in caffeine treatment group were given caffeine citrate, the first dose was 20 mg/kg, intravenous injection, and the maintenance dose was 5 mg/kg/d, QD, intravenous injection after 24 hours. The incidence of apnea, bronchopulmonary dysplasia, patent ductus arteriosus, intracranial hemorrhage, tachycardia, feeding intolerance and hyperglycemia, and the duration of n-CPAP use during treatment were statistically analyzed. Part: The subjects were 132 premature infants (excluding developmental malformations, sepsis, congenital heart disease and other factors) admitted to the neonatal department of Tianjin Central Obstetrics and Gynecology Hospital from January 2014 to December 2014. They were randomly divided into caffeine treatment group and control group. The control group did not use methylxanthine. The incidence of apnea, the duration of ventilator and n-CPAP, the incidence of tachycardia, patent ductus arteriosus, and feeding intolerance in the two groups were 48 hours after treatment. The incidence of intracranial hemorrhage, the incidence of bronchopulmonary dysplasia, the rate of weight gain and length of hospitalization were compared, and the statistical differences were analyzed. The incidence of PDA, intracranial hemorrhage, tachycardia, hyperglycemia and feeding intolerance were significantly lower in caffeine group than in aminophylline group (P 0.05). 132 premature infants were randomly divided into two groups. The incidence of apnea, the duration of n-CPAP, the incidence of PDA, the incidence of intracranial hemorrhage, the length of hospitalization and the duration of hospitalization were compared between the caffeine treatment group and the control group. The incidence of BPD was significantly lower in the caffeine treatment group than in the control group (P 0.05). There was no significant difference in the incidence of tachycardia, feeding intolerance, necrotizing enterocolitis and body weight gain rate (P 0.05). Conclusion: 1. There was no significant difference between caffeine and aminophylline in the treatment of primary apnea in premature infants. Caffeine is superior to aminophylline in the choice of drugs for primary apnea in premature infants. 2. Preventive administration of caffeine 24 hours after birth can effectively avoid the occurrence of primary apnea. Preventive use of caffeine can also shrink. Short-term use of n-CPAP can reduce the incidence of postnatal PDA and intracranial hemorrhage, and shorten the length of hospitalization. Many studies have shown that caffeine treatment has no obvious adverse reactions. Therefore, caffeine is recommended to prevent apnea 24 hours after birth in premature infants, so as to avoid frequent apnea attacks on the organs of premature infants. The injury of the system can improve the prognosis of premature infants.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2015
【分類號】：R722.6

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相關(guān)期刊論文 前1條

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本文編號：2205303