| Objective : In order to find a more reasonable and effective dose of caffeine maintenance treatment,the clinical experimental studies of caffeine in the treatment of premature apnea were summarized and analyzed by means of systematic evaluation,and the effectiveness,safety,adverse reactions and complications of different doses were evaluated,so as to provide more reliable evidence-based medical evidence for the treatment of premature apnea by caffeine.Methods:Formulate relevant retrieval strategies and conduct comprehensive retrieval of databases at home and abroad.The first Chinese databases searched are Wanfang database,CNKI,CBM and VIP;The foreign language databases are Pub Med,EMBASE and Cochrane Library,and the clinical registration research centers at home and abroad are searched.Secondly,the search content is all clinical randomized controlled trials of caffeine in the treatment of apnea in preterm infants.The search period is from January 2011 to December 31,2021.The established inclusion and exclusion criteria were used for literature screening,and the general characteristics and outcome indicators of the study were recorded and summarized.The methods described in Cochrane manual were used to evaluate the quality and bias risk of the selected studies,and the corresponding charts were drawn.Finally,Review Manager 5 3 software for statistical analysis,calculate the relative risk RR and 95% confidence interval(95% CI),and draw the forest map and funnel map.Results:A total of 8 RCT studies were included.The systematic analysis of the outcome indicators of the study results showed that:(1)in terms of curative effect,compared with the low maintenance dose(5-10 mg / kg / d),the high maintenance dose caffeine treatment could reduce the frequency of AOP attack(MD =-5.66,95% CI(-6.35,-4.97),P < 0.00001)and the cumulative recording time of AOP(MD =-2.68,95%CI(-2.98,-2.38),P < 0.00001),It decreased the rate of extubation failure(RR = 0.52,95% CI(0.39,0.69),P < 0.00001),but there was no significant difference in the incidence of death before discharge(RR = 0.76,95% CI(0.48,1.18),P = 0.22 > 0.05). (2)In terms of complications,high maintenance dose(15-20 mg / kg / D)could reduce the incidence of BPD(RR = 0.77,95% CI(0.63,0.96),P = 0.02 > 0.05),but there was no significant difference in ROP(RR = 1.03,95% CI(0.73,1.45),P = 0.87 > 0.05),NEC(RR = 0.89,95% CI(0.48,1.64),P = 0.71 > 0.05),IVH(RR = 1.03,95% CI(0.74,1.44),P = 0.85 > 0.05),PVL(RR = 1.49,95% CI(0.54,4.07),P = 0.44 > 0.05).(3)In terms of adverse reactions,high maintenance dose(15-20 mg / kg / d)was more likely to produce adverse reactions of tachycardia(RR = 1.89,95% CI(1.25,2.84),P = 0.002< 0.05),but there was no significant difference in feeding intolerance(RR = 0.96,95%CI(0.60,1.54),P = 0.88 > 0.05)and the incidence of hypertension(RR = 1.80,95% CI(0.61,5.30),P = 0.29 > 0.05).Conclusion:(1)in the treatment effect,high maintenance dose of caffeine(15-20mg/kg/d)can effectively improve the symptoms of apnea,reduce the cumulative recording time of apnea,and improve the success rate of extubation.(2)In terms of complications,high maintenance dose of caffeine(15-20mg/kg/d)can effectively reduce the incidence rate of BPD in children.(3)In terms of adverse reactions,high maintenance dose of caffeine(15-20mg/kg/d)is more likely to induce tachycardia,but under close drug reaction monitoring,high maintenance dose of caffeine is still recommended. |
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