中华实用儿科临床杂志
中華實用兒科臨床雜誌
중화실용인과림상잡지
Journal of Applied Clinical Pediatrics
2014年
18期
1381-1384
,共4页
李文斌%常立文%刘伟%容志惠%蔡保欢
李文斌%常立文%劉偉%容誌惠%蔡保歡
리문빈%상립문%류위%용지혜%채보환
早产儿呼吸暂停%氨茶碱%纳洛酮%枸橼酸咖啡因
早產兒呼吸暫停%氨茶堿%納洛酮%枸櫞痠咖啡因
조산인호흡잠정%안다감%납락동%구연산가배인
Apnea of prematurity%Aminophylline%Naloxone%Caffeine citrate
目的 探讨氨茶碱、枸橼酸咖啡因以及氨茶碱联合纳洛酮防治早产儿呼吸暂停(AOP)的疗效.方法 选择2010年1月至2012年1月在华中科技大学同济医学院附属同济医院儿科接受住院治疗的出生胎龄＜34周、出生体质量＜1 500 g的极低出生体质量和超低出生体质量儿94例.分为3组:(1)氨茶碱组(30例),首剂负荷量4～5 mg/kg,12 h后给予维持量2 mg/kg,每12h1次,静脉泵入;(2)枸橼酸咖啡因组(32例),枸橼酸咖啡因首剂负荷量20 mg/kg,24h后给予维持量5 mg/kg,1次/d,静脉泵入;(3)氨茶碱联合纳洛酮组(观察组,32例),氨茶碱使用方法同氨茶碱组,同时予以纳洛酮每次0.1 mg/kg加入9 g/L盐水2 mL中静脉推注,每12h1次,氨茶碱首剂使用6h后,即给予纳洛酮治疗,随后二者交替使用.观察患儿呼吸暂停、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)和脑损伤发生率及病死率等相关情况,并记录药物相关不良反应.结果 1.各组患儿在性别、出生胎龄、出生体质量、产前孕母糖皮质激素应用、受孕及分娩方式、多胎妊娠、5 min Apgar评分、接受氧疗例数、辅助通气(包括经鼻持续呼吸道正压通气及机械通气)和表面活性物质的应用等方面差异均无统计学意义(P均＞0.05).2.与氨茶碱组比较,枸橼酸咖啡因组和观察组呼吸暂停发生率明显降低,差异有统计学意义(F=6.704,P＜0.05);而枸橼酸咖啡因组和观察组比较差异无统计学意义(P＞0.05).3.各组患儿在病死率、氧疗持续时间、ROP和脑损伤发生率、耳听测试未通过率、出院时纠正胎龄、出院时体质量以及住院时间和费用等方面则差异均无统计学意义(P均＞0.05).4.枸橼酸咖啡因组和观察组BPD发生率[9.4％(3/32例),12.5％(4/32例)]低于氨茶碱组[20.0％(6/30例)],但差异无统计学意义(P＞0.05).5.各组患儿均未发现与用药相关的明显不良反应.结论 氨茶碱联合纳洛酮防治AOP疗效与枸橼酸咖啡因相似,且安全有效.
目的 探討氨茶堿、枸櫞痠咖啡因以及氨茶堿聯閤納洛酮防治早產兒呼吸暫停(AOP)的療效.方法 選擇2010年1月至2012年1月在華中科技大學同濟醫學院附屬同濟醫院兒科接受住院治療的齣生胎齡＜34週、齣生體質量＜1 500 g的極低齣生體質量和超低齣生體質量兒94例.分為3組:(1)氨茶堿組(30例),首劑負荷量4～5 mg/kg,12 h後給予維持量2 mg/kg,每12h1次,靜脈泵入;(2)枸櫞痠咖啡因組(32例),枸櫞痠咖啡因首劑負荷量20 mg/kg,24h後給予維持量5 mg/kg,1次/d,靜脈泵入;(3)氨茶堿聯閤納洛酮組(觀察組,32例),氨茶堿使用方法同氨茶堿組,同時予以納洛酮每次0.1 mg/kg加入9 g/L鹽水2 mL中靜脈推註,每12h1次,氨茶堿首劑使用6h後,即給予納洛酮治療,隨後二者交替使用.觀察患兒呼吸暫停、支氣管肺髮育不良(BPD)、早產兒視網膜病(ROP)和腦損傷髮生率及病死率等相關情況,併記錄藥物相關不良反應.結果 1.各組患兒在性彆、齣生胎齡、齣生體質量、產前孕母糖皮質激素應用、受孕及分娩方式、多胎妊娠、5 min Apgar評分、接受氧療例數、輔助通氣(包括經鼻持續呼吸道正壓通氣及機械通氣)和錶麵活性物質的應用等方麵差異均無統計學意義(P均＞0.05).2.與氨茶堿組比較,枸櫞痠咖啡因組和觀察組呼吸暫停髮生率明顯降低,差異有統計學意義(F=6.704,P＜0.05);而枸櫞痠咖啡因組和觀察組比較差異無統計學意義(P＞0.05).3.各組患兒在病死率、氧療持續時間、ROP和腦損傷髮生率、耳聽測試未通過率、齣院時糾正胎齡、齣院時體質量以及住院時間和費用等方麵則差異均無統計學意義(P均＞0.05).4.枸櫞痠咖啡因組和觀察組BPD髮生率[9.4％(3/32例),12.5％(4/32例)]低于氨茶堿組[20.0％(6/30例)],但差異無統計學意義(P＞0.05).5.各組患兒均未髮現與用藥相關的明顯不良反應.結論 氨茶堿聯閤納洛酮防治AOP療效與枸櫞痠咖啡因相似,且安全有效.
목적 탐토안다감、구연산가배인이급안다감연합납락동방치조산인호흡잠정(AOP)적료효.방법 선택2010년1월지2012년1월재화중과기대학동제의학원부속동제의원인과접수주원치료적출생태령＜34주、출생체질량＜1 500 g적겁저출생체질량화초저출생체질량인94례.분위3조:(1)안다감조(30례),수제부하량4～5 mg/kg,12 h후급여유지량2 mg/kg,매12h1차,정맥빙입;(2)구연산가배인조(32례),구연산가배인수제부하량20 mg/kg,24h후급여유지량5 mg/kg,1차/d,정맥빙입;(3)안다감연합납락동조(관찰조,32례),안다감사용방법동안다감조,동시여이납락동매차0.1 mg/kg가입9 g/L염수2 mL중정맥추주,매12h1차,안다감수제사용6h후,즉급여납락동치료,수후이자교체사용.관찰환인호흡잠정、지기관폐발육불량(BPD)、조산인시망막병(ROP)화뇌손상발생솔급병사솔등상관정황,병기록약물상관불량반응.결과 1.각조환인재성별、출생태령、출생체질량、산전잉모당피질격소응용、수잉급분면방식、다태임신、5 min Apgar평분、접수양료례수、보조통기(포괄경비지속호흡도정압통기급궤계통기)화표면활성물질적응용등방면차이균무통계학의의(P균＞0.05).2.여안다감조비교,구연산가배인조화관찰조호흡잠정발생솔명현강저,차이유통계학의의(F=6.704,P＜0.05);이구연산가배인조화관찰조비교차이무통계학의의(P＞0.05).3.각조환인재병사솔、양료지속시간、ROP화뇌손상발생솔、이은측시미통과솔、출원시규정태령、출원시체질량이급주원시간화비용등방면칙차이균무통계학의의(P균＞0.05).4.구연산가배인조화관찰조BPD발생솔[9.4％(3/32례),12.5％(4/32례)]저우안다감조[20.0％(6/30례)],단차이무통계학의의(P＞0.05).5.각조환인균미발현여용약상관적명현불량반응.결론 안다감연합납락동방치AOP료효여구연산가배인상사,차안전유효.
Objective To investigate the efficacy and safety of aminophylline,caffeine citrate and aminophylline combined with naloxone in prevention of apnea of prematurity(AOP).Methods Ninety-four infants with a birth weight ＜ 1 500 g and gestational age ＜ 34 weeks admitted to Department of Pediatrics,Tongji Hospital Affiliated to Tongji Medical College,Huazhong University of Science and Technology between Jan.2010 and Jan.2012 were randomly divided into 3 groups.(1) Aminophylline group (n =30):30 infants received a loading dose of 4-5 mg/kg of aminophylline and then maintained by a dose of 2 mg/kg,with intravenous drip q12 h.(2) Caffeine citrate group(n =32):a loading dose of 20 mg/kg of caffeine citrate was followed by a daily maintained dose of 5 mg/kg,with intravenous drip per day.(3) Aminophylline combined naloxone group (observation group,n =32):32 infants were treated with Aminophylline combined with naloxone.After 6 hours of the first dose of aminophylline,a dose of 0.1 mg/kg naloxone was injected,q12 h.Then the two drugs were used alternately.The mortality and incidence of AOP,bronchopulmonary dysplasia(BPD),retinopathy of prematurity (ROP) and brain injury were evaluated,and drug-related side effects were recorded.Results 1.There was no significant difference in gender,gestational age,birth weight,maternal antenatal glucocorticoid application,pregnancy (including multiple pregnancy) and delivery,5 min Apgar score,oxygen therapy,and the application of positive airway pressure as well as pulmonary surfactant among the 3 groups(all P ＞0.05).2.Compared with aminophylline group,the incidence of apnea of caffeine group and observation group were significantly lower (F =6.704,P ＜ 0.05),but there was no significant difference between caffeine group and observation group (P ＞0.05).3.There was no statistically significant difference in mortality,duration of oxygen therapy,the incidence of ROP,brain injury and hearing loss,postmenstrual age,body weight at discharge,the duration and cost of hospitalization among the 3 groups(all P ＞0.05).4.The BPD incidence in caffeine group[9.4％ (3/32 cases)] and observation group [12.5％ (4/32 cases)] were lower than that in Aminophylline group [20.0％ (6/30 cases)],but there was no statistical significance among the 3 groups(P ＞ 0.05).5.No drug-related side effects were recorded in the 3 groups.Conclusions It is safe and effective to use aminophylline combined with naloxone in prevention of AOP,and its efficiency is similar to caffeine citrate.
