极早早产儿枸橼酸咖啡因停用时机的临床研究

The timing of withdrawal from caffeine citrate in very preterm infants

摘要:

目的 分析不同时间点停用枸橼酸咖啡因极早早产儿的临床特征及结局。 方法 回顾性收集2016年1月1日至2020年11月30日于中南大学湘雅二医院新生儿专科住院治疗的胎龄小于32周的早产儿的数据资料，将符合研究标准的患儿根据枸橼酸咖啡因停用时间分为住院最后1周前停用组及住院最后1周内停用组，分析比较两组患儿临床特征、枸橼酸咖啡因使用特点、住院时间及费用、呼吸支持强度改变，以及早产并发症发生的差异。 结果 纳入研究对象共403例，住院最后1周前停用组纳入285例，住院最后1周内停用组纳入118例。两组早产儿基本临床特征差异无统计学意义（P>0.05）。与住院最后1周前停用组比较，住院最后1周内停用组患儿枸橼酸咖啡因使用时间较长，但住院时间更短，停用后呼吸支持强度增加的情况更少见，中/重度支气管肺发育不良发生率更低（P<0.05）。 结论 较长疗程的枸橼酸咖啡因治疗对极早早产儿的近期临床结局更有益处。

Abstract:

Objective To study the clinical features and outcome of very preterm infants withdrawn from caffeine citrate at different time points. Methods A retrospective analysis was performed on the medical data of the preterm infants with a gestational age of <32 weeks, who were hospitalized in the Division of Neonatology, the Second Xiangya Hospital of Central South University, from January 1, 2016 to November 30, 2020. According to the time of withdrawal from caffeine citrate, the infants who met the study criteria were divided into the group with withdrawal before the last week of hospitalization and the group with withdrawal within the last week of hospitalization. The two groups were compared in terms of clinical features, features of citric caffeine use, length of hospital stay and hospital costs, change in the intensity of respiratory support, and preterm complications. Results A total of 403 preterm infants were enrolled, with 285 infants in the group with withdrawal before the last week of hospitalization and 118 infants in the group with withdrawal within the last week of hospitalization. There were no significant differences in clinical features between the two groups (P>0.05). Compared with the group with withdrawal before the last week of hospitalization, the group with withdrawal within the last week of hospitalization had a significantly longer duration of the use of caffeine citrate, a significantly shorter length of hospital stay, a significantly lower rate of increased intensity of respiratory support after withdrawal, and a significantly lower incidence rate of moderate or severe bronchopulmonary dysplasia (P<0.05). Conclusions A relatively long course of caffeine citrate treatment is more beneficial to the short-term clinical outcome of very preterm infants.