PDF(1173 KB)
早期咖啡因治疗对呼吸窘迫综合征早产儿呼吸机需求的影响研究
韦巧珍, 苏萍, 韩进天, 张霞, 段玉会
中国当代儿科杂志 ›› 2016, Vol. 18 ›› Issue (12) : 1227-1231.
PDF(1173 KB)
PDF(1173 KB)
早期咖啡因治疗对呼吸窘迫综合征早产儿呼吸机需求的影响研究
Effect of early caffeine treatment on the need for respirator therapy in preterm infants with respiratory distress syndrome
目的 研究早期静脉注射咖啡因对呼吸窘迫综合征（RDS）早产儿的影响。方法 通过前瞻性临床对照研究，选择进行机械通气的RDS早产儿59例，分成咖啡因组（n=30）和对照组（n=29）。咖啡因组在生后12~24 h开始使用咖啡因，对照组在计划拔除气管插管前4~6 h开始给予咖啡因（剂量同咖啡因组）。比较两组呼吸机参数，以及呼吸机相关性肺炎（VAP）、呼吸暂停（AOP）等并发症发生情况。结果 咖啡因组最高吸气峰压（PIP）、最高吸入氧浓度（FiO2）及VAP发生率明显低于对照组（P < 0.05）。咖啡因组插管时间、NCPAP时间、总需氧时间均明显短于对照组（P < 0.05），拔管后首次AOP发生时间明显迟于对照组（P < 0.05），拔管后1~2 d AOP的发生次数也明显少于对照组（P < 0.01）。结论 早期应用咖啡因治疗能减少RDS早产儿对辅助通气的需求，有助于早期拔管及撤离呼吸机，减少VAP及拔管后AOP的发生。
Objective To study the efficacy of early caffeine treatment in preterm infants with respiratory distress syndrome (RDS). Methods A prospective controlled clinical trial was performed. A total of 59 preterm infants with RDS were enrolled and divided into a caffeine group (30 infants) and a control group (29 infants). Caffeine was administered in the caffeine group and control group at the same dosage at 12-24 hours after birth and before extubation respectively. The respirator parameters and the incidence rates of ventilator-associated pneumonia (VAP) and apnea were compared between the two groups. Results Compared with the control group, the caffeine group had significantly lower peak inspiratory pressure, peak fraction of inspired oxygen, and incidence rate of VAP (P < 0.05), as well as significantly shorter intubation time, NCPAP time, and total duration of oxygen supply (P < 0.05). In addition, the caffeine group had a significantly longer time to first onset of apnea after extubation (P < 0.05) and significantly fewer times of onset of apnea 1-2 days after extubation (P < 0.01), as compared with the control group. Conclusions Early caffeine treatment can reduce the need for assisted ventilation in preterm infants with RDS, help with early extubation and ventilator weaning, reduce the oxygen time in the late stage, reduce the incidence of VAP, and prevent the development of apnea after extubation.
Caffeine / Respirator / Respiratory distress syndrome / Preterm infant
[1] Carvalho CG, Silveira RC, Procianoy RS. Ventilator-induced lung injury in preterm infants[J]. Rev Bras Ter Intensiva, 2013, 25(4):319-326.
[2] Abdel-Hady H, Nasef N, Shabaan AE, et al. Caffeine therapy in preterm infants[J]. World J Clin Pediatr, 2015, 4(4):81-93.
[3] Davis PG, Schmidt B, Roberts RS, et al. Caffeine for apnea of prematurity trial:benefits may vary in subgroups[J]. J Pediatr, 2010, 156(3):382-387.
[4] Gerull R, Manser H, Küster H, et al. Increase of caffeine and decrease of corticosteroids for extremely low-birthweight infants with respiratory failure from 1997 to 2011[J]. Acta Paediatr, 2013, 102(12):1154-1159.
[5] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 第4版. 北京:人民卫生出版社, 2011.
[6] Gharehbaghi MM, Peirovifar A, Ghojazadeh M. Risk factors contributing to the failure of surfactant administration with INSURE method[J]. J Pioneer Med Sci, 2014, 4(2):55-59.
[7] Habre W. Neonatal ventilation[J]. Best Pract Res Clin Anaesthesiol, 2010, 24(3):353-364.
[8] Lago P, Bettiol T, Salvadori S, et al. Safety and efficacy of ibuprofen versus indomethacin in preterm infants treated for patent ductus arteriosus:a randomised controlled trial[J]. Eur J Pediatr, 2002, 161(4):202-207.
[9] Geffers C, Baerwolff S, Schwab F, et al. Incidence of healthcare-associated infections in high-risk neonates:results from the German surveillance system for very-low-birthweight infants[J]. J Hosp Infect, 2008, 68(3):214-221.
[10] Abu Jawdeh EG, O'Riordan M, Limrungsikul A, et al. Methylxanthine use for apnea of prematurity among an international cohort of neonatologists[J]. J Neonatal Perinatal Med, 2013, 6(3):251-256.
[11] Picone S, Bedetta M, Paolillo P. Caffeine citrate:when and for how long. A literature review[J]. J Matern Fetal Neonatal Med, 2012, 25 Suppl 3:11-14.
[12] Dobson NR, Patel RM, Smith PB, et al. Trends in caffeine use and association between clinical outcomes and timing of therapy in very low birth weight infants[J]. J Pediatr, 2014, 164(5):992-998.
[13] Patel RM, Leong T, Carlton DP, et al. Early caffeine therapy and clinical outcomes in extremely preterm infants[J]. J Perinatol, 2013, 33(2):134-140.
[14] Kassim Z, Greenough A, Rafferty GF. Effect of caffeine on respiratory muscle strength and lung function in prematurely born, ventilated infants[J]. Eur J Pediatr, 2009, 168(12):1491-1495.
[15] Yoder B, Thomson M, Coalson J. Lung function in immature baboons with respiratory distress syndrome receiving early caffeine therapy:a pilot study[J]. Acta Paediatr, 2005, 94(1):92-98.
[16] Domm W, Misra RS, O'Reilly MA. Affect of early life oxygen exposure on proper lung development and response to respiratory viral infections[J]. Front Med (Lausanne), 2015, 2:55.
[17] Darlow BA, Marschner SL, Donoghoe M, et al. Randomized controlled trial of oxygen saturation targets in very preterm infants:two year outcomes[J]. J Pediatr, 2014, 165(1):30-35.
[18] Weichelt U, Cay R, Schmitz T, et al. Prevention of hyperoxia-mediated pulmonary inflammation in neonatal rats by caffeine[J]. Eur Respir J, 2013, 41(4):966-973.
[19] Nagatomo T, Jiménez J, Richter J, et al. Caffeine prevents hyperoxia-induced functional and structural lung damage in preterm rabbits[J]. Neonatology, 2016, 109(4):274-281.
[20] Tan B, Xian-Yang X, Zhang X, et al. Epidemiology of pathogens and drug resistance of ventilator-associated pneumonia in Chinese neonatal intensive care units:a meta-analysis[J]. Am J Infect Control, 2014, 42(8):902-910.
[21] Chavez-Valdez R, Wills-Karp M, Ahlawat R, et al. Caffeine modulates TNF-alpha production by cord blood monocytes:the role of adenosine receptors[J]. Pediatr Res, 2009, 65(2):203-208.
[22] Rivkees SA, Wendler CC. Adverse and protective influences of adenosine on the newborn and embryo:implications for preterm white matter injury and embryo protection[J]. Pediatr Res, 2011, 69(4):271-278.
[23] Schmidt B, Roberts RS, Davis P, et al. Long-term effects of caffeine therapy for apnea of prematurity[J]. N Engl J Med, 2007, 357(19):1893-1902.
[24] Park HW, Lim G, Chung SH, et al. Early caffeine use in very low birth weight infants and neonatal outcomes:A systematic review and Meta-analysis[J]. J Korean Med Sci, 2015, 30(12):1828-1835.
[25] Skouroliakou M, Bacopoulou F, Markantonis SL. Caffeine versus theophylline for apnea of prematurity:a randomised controlled trial[J]. J Paediatr Child Health, 2009, 45(10):587-592.
广西医科大学青年科技基金课题（GXMUYSF201309）；吴阶平医学基金会项目（320.6750.14186）。
