【摘要】：目的早產(chǎn)兒呼吸暫停是目前新生兒重癥監(jiān)護中面臨的主要臨床問題之一,若不能妥善治療將引起一系列非常嚴重的并發(fā)癥。國外文獻指出與氨茶堿相比,枸櫞酸咖啡因治療早產(chǎn)兒呼吸暫停所具有治療窗更寬、吸收更加可靠與半衰期更長的優(yōu)勢。國內自2013年引入枸櫞酸咖啡因,目前還沒有足夠的證據(jù)支持其治療效果,本文的目的就是以Meta分析的方式比較枸櫞酸咖啡因與氨茶堿治療早產(chǎn)兒呼吸暫停的臨床療效。方法對Pub Med、Embase、Cochrane registry of controlled clinical trials、Sinomed、CNKI、Wan Fang Data以及CQVIP等數(shù)據(jù)庫進行系統(tǒng)檢索2016年3月31日以前的所有對比枸櫞酸咖啡因與氨茶堿治療早產(chǎn)兒呼吸暫停臨床療效的隨機對照試驗研究,文章語言設置為中文與英文,采用改良Jadad量表評價文獻質量并提取數(shù)據(jù)進行Meta分析。結果本篇Meta分析共納入26篇相關研究的文章,早產(chǎn)兒呼吸暫停采用枸櫞酸咖啡因進行治療1~3 d的有效率明顯高于氨茶堿(86.33%vs.64.92%,RR=1.33,P0.000 01),采用治療1~3 d呼吸暫停次數(shù)進行比較兩者并無顯著差異(MD=-0.01,P=0.83)。氨茶堿治療的早產(chǎn)兒不良反應發(fā)生率明顯高于枸櫞酸咖啡因治療的患兒(36.75%vs.11.30%,RR=0.32,P0.000 01),尤其是心動過速(RR=0.20,P0.000 01)、喂養(yǎng)不耐受(RR=0.34,P0.000 01)、煩躁激惹(RR=0.35,P=0.000 1)、高血糖(RR=0.24,P0.000 1)及血壓升高(RR=0.16,P=0.03)的發(fā)生率明顯高于枸櫞酸咖啡因治療組患兒。結論目前研究結果表明,枸櫞酸咖啡因治療早產(chǎn)兒呼吸暫停有效率高且副作用小,因而更適宜用于早產(chǎn)兒呼吸暫停的治療,值得臨床推廣。
[Abstract]:Objective apnea of premature infants is one of the main clinical problems in neonatal intensive care at present. If not properly treated, it will cause a series of very serious complications. Compared with aminophylline, caffeine citrate has the advantages of wider therapeutic window, more reliable absorption and longer half-life compared with aminophylline in the treatment of apnea in premature infants. Since the introduction of caffeine citrate in China in 2013, there is not enough evidence to support its therapeutic effect. The purpose of this paper is to compare the clinical efficacy of caffeine citrate and aminophylline in the treatment of apnea in premature infants by Meta analysis. Methods A randomized controlled trial was conducted to systematically search the databases of Pub Med,Embase,Cochrane registry of controlled clinical trials,Sinomed,CNKI,Wan Fang Data and CQVIP for comparing the clinical efficacy of caffeine citrate and aminophylline in the treatment of apnea in premature infants before March 31, 2016. The Chinese and English languages were used to evaluate the literature quality by using the modified Jadad scale and to extract the data for Meta analysis. Results this Meta analysis included 26 articles related to the study, The effective rate of apnea in premature infants treated with caffeine citrate for 1 to 3 days was significantly higher than that of aminophylline (86.33vs.64.92rRRRRRR1.33 P0.00001). There was no significant difference in apnea times between the two groups (MD=-0.01,P=0.83). The incidence of adverse reactions in premature infants treated with aminophylline was significantly higher than that in infants treated with caffeine citrate (36.75 vs 11.30), especially in patients with RR=0.20,P0.000 01, RR=0.34,P0.000 01, RR=0.35,P=0.000 1, RR=0.24,P0.000 1 and high blood pressure (RR=0.16,P=0.03). It was significantly higher than that of caffeine citrate treatment group. Conclusion the results show that caffeine citrate is more effective and has less side effects in the treatment of apnea in premature infants, so it is more suitable for the treatment of apnea in premature infants and is worth popularizing in clinic.
【作者單位】： 山西醫(yī)科大學;山西省兒童醫(yī)院新生兒科;南方醫(yī)科大學;
【分類號】：R722.6
，

本文編號：2246980