目的 探讨氢溴酸东莨菪碱联合枸橼酸咖啡因治疗早产呼吸暂停患儿（AOP）的安全性与有效性。方法 选取天津市中心妇产科医院2019年1月-2020年1月收治的早产呼吸暂停患儿87例，随机分成对照组（43例）和治疗组（44例）。对照组患儿静脉泵入枸橼酸咖啡因注射液，首剂负荷量20 mg/kg，24 h后以20 mg/（kg·d）的剂量维持，待患儿呼吸暂停消失后，继续使用5~7 d。治疗组患儿在对照组基础上静脉推注氢溴酸东莨菪碱注射液，每次0.03~0.05 mg/kg，4~6 h/次，每日总用量应低于0.1 mg/kg。观察两组患者临床疗效，同时比较治疗前后两组患者AOP消失时间、总氧疗时间、潮气量、达峰容积比、达峰时间比、每分通气量，血清β-内啡肽和腺苷水平，及AOP次数。结果 治疗后，对照组临床有效率为83.72%，显著低于治疗组的97.73%，两组比较差异具有统计学意义（P<0.05）。治疗后，治疗组患儿AOP消失时间、总氧疗时间均明显短于对照组（P<0.05），且潮气量、达峰容积比、达峰时间比及每分通气量均要优于对照组（P<0.05）。治疗后，两组患儿血清β-内啡肽、腺苷水平均明显低于治疗前，且AOP次数在用药48 h后也明显减少（P<0.05），且治疗组β-内啡肽和腺苷水平及AOP次数显著小于对照组（P<0.05）。结论 氢溴酸东莨菪碱联合枸橼酸咖啡因治疗早产儿呼吸暂停疗效确切，能够有效改善患儿临床症状与肺功能。

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

天津市科技成果项目（20171522）