不同剂量枸橼酸咖啡因用于早产儿呼吸暂停的疗效和安全性系统评价

目的:评价不同剂量的枸橼酸咖啡因对早产儿呼吸暂停(AOP)的疗效和安全性。方法:检索中英文数据库,收集关于不同剂量枸橼酸咖啡因治疗早产儿呼吸暂停的随机对照试验。采用Review Manager 5.3软件对纳入的文献进行系统评价。结果:共纳入7篇文献,879例患者。Meta分析结果显示,高剂量的枸橼酸咖啡因显著降低撤机失败率RR=0.65,95%CI(0.46,0.82),P=0.001];不同的枸橼酸咖啡因剂量组在院内病死率方面无显著差异RR=0.76,95%CI(0.44,1.33),P=0.34];高剂量组具有更低的支气管肺发育不良发生率RR=0.72,95%CI(0.58,0.89),P=0.003],同时显著增加心动过速的发生率RR=2.36,95%CI(1.53,3.65),P=0.000 1]。结论:现有证据提示,高剂量枸橼酸咖啡因用于早产儿呼吸暂停有更好的疗效,但有增加不良反应的风险。鉴于纳入研究例数较少且缺少远期评价,仍需更多的随机对照试验。

Efficacy and safety of different doses of caffeine citrate in the treatment of apnea of prematurity: a systematic review

OBJECTIVE To evaluate the efficacy and safety of different doses of caffeine citrate on apnea of prematurity (AOP).METHODS The randomized controlled trials involving different doses of caffeine citrate on apnea of prematurity were collected and identified from several Databases.Reviewers extracted data and evaluated the quality of the included studies,and then meta-analysis was performed using RevMan 5.3 software.RESULTS Seven trials including 879 cases of patients were included.Systematic review showed that in AOP patients,there was a significant difference in the rate of extubation failureRR=0.65,95%CI (0.46,0.82),P=0.001] at different doses of citrate caffeine.High dose was as well tolerated as low dose caffeine,with no significant difference in terms of neonatal mortality before hospital dischargeRR=0.76,95%CI(0.44,1.33),P=0.34].Meanwhile,the high dose caffeine significantly reduced the risk of BPDRR=0.72,95%CI (0.58,0.89),P=0.003],and was associated with significant increase in episodes of tachycardiaRR=2.36,95%CI (1.53,3.65),P=0.000 1].CONCLUSION The available evidence suggests that high doses of caffeine citrate are effective in AOP with increased risk of adverse reactions.More randomized controlled trials are still needed given the small number of included studies and the lack of long-term evaluation.