目的 探討氫溴酸東莨菪堿聯(lián)合枸櫞酸咖啡因治療早產(chǎn)呼吸暫?；純海ˋOP）的安全性與有效性。方法 選取天津市中心婦產(chǎn)科醫(yī)院2019年1月-2020年1月收治的早產(chǎn)呼吸暫停患兒87例，隨機(jī)分成對(duì)照組（43例）和治療組（44例）。對(duì)照組患兒靜脈泵入枸櫞酸咖啡因注射液，首劑負(fù)荷量20 mg/kg，24 h后以20 mg/（kg·d）的劑量維持，待患兒呼吸暫停消失后，繼續(xù)使用5~7 d。治療組患兒在對(duì)照組基礎(chǔ)上靜脈推注氫溴酸東莨菪堿注射液，每次0.03~0.05 mg/kg，4~6 h/次，每日總用量應(yīng)低于0.1 mg/kg。觀察兩組患者臨床療效，同時(shí)比較治療前后兩組患者AOP消失時(shí)間、總氧療時(shí)間、潮氣量、達(dá)峰容積比、達(dá)峰時(shí)間比、每分通氣量，血清β-內(nèi)啡肽和腺苷水平，及AOP次數(shù)。結(jié)果 治療后，對(duì)照組臨床有效率為83.72%，顯著低于治療組的97.73%，兩組比較差異具有統(tǒng)計(jì)學(xué)意義（P<0.05）。治療后，治療組患兒AOP消失時(shí)間、總氧療時(shí)間均明顯短于對(duì)照組（P<0.05），且潮氣量、達(dá)峰容積比、達(dá)峰時(shí)間比及每分通氣量均要優(yōu)于對(duì)照組（P<0.05）。治療后，兩組患兒血清β-內(nèi)啡肽、腺苷水平均明顯低于治療前，且AOP次數(shù)在用藥48 h后也明顯減少（P<0.05），且治療組β-內(nèi)啡肽和腺苷水平及AOP次數(shù)顯著小于對(duì)照組（P<0.05）。結(jié)論 氫溴酸東莨菪堿聯(lián)合枸櫞酸咖啡因治療早產(chǎn)兒呼吸暫停療效確切，能夠有效改善患兒臨床癥狀與肺功能。

Objective To explore the safety and efficacy of scopolamine combined with caffeine citrate in treatment of apnea of prematurity. Methods Children (87 cases) with apnea of prematurity in Tianjin Central Hospital of Gynecology Obstetrics from January 2019 to January 2020 were randomly divided into control (43 cases) and treatment (44 cases) groups. Children in the control group were intravenous pumped administered with Caffeine Citrate Injection, first loading dose was 20 mg/kg, and the maintenance dose was 20 mg/(kg·d) after 24 h, and treated for another 5-7 d after the apnea disappeared. Children in the treatment group were iv administered with Scopolamine Hydrobromide Injection on the basis of the control group, 0.03-0.05 mg/kg for 4-6 h, and the total daily dosage should be lower than 0.1 mg/kg. Children in two groups were treated for 10 d. After treatment, the clinical efficacy was evaluated, and the disappearance time of AOP, total oxygen therapy time, tidal volume, peak volume ratio, peak time ratio, ventilation volume per minute,and serum β-endorphin level, adenosine, and AOP times in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control group was 83.72%, which was significantly lower than 83.72% in the treatment group, and there were differences between two groups (P<0.05). After treatment, the disappearance time of AOP and total oxygen therapy time in the treatment group were significantly shorter than that in the control group (P<0.05), and the tidal volume, peak volume ratio, peak time ratio, ventilation volume per minute in the treatment group were significantly better than those in the control group (P<0.05). After treatment, the serum β-endorphin level and adenosine in two groups were significantly decreased (P<0.05), and the AOP times were significantly increased (P<0.05), and the serum β-endorphin level and adenosine were significantly less than those in the control group (P<0.05). Conclusion Scopolamine combined with caffeine citrate is effective in the treatment of premature infants with apnea, and can effectively improve the clinical symptoms and lung function, which is worthy of further promotion and verification in clinical practice.

R985

天津市科技成果項(xiàng)目（20171522）