目的 探討咖啡因聯(lián)合洛貝林治療新生兒原發(fā)性呼吸暫停（AOP）的臨床療效。方法 選取2016年2月-2017年6月在隨州市中心醫(yī)院診治的原發(fā)性AOP患兒86例，隨機分為對照組和治療組，每組各43例。對照組靜脈推注鹽酸洛貝林注射液，0.3~3 mg/次，重復推注則間隔20~30 min，累計劑量不超過20 mg/d。治療組靜脈推注枸櫞酸咖啡因注射液，與鹽酸洛貝林注射液交替使用，首劑量20 mg/kg，24 h后以5 mg/kg維持，根據(jù)情況追加維持量10 mg/kg，1次/d。兩組均連續(xù)治療5 d，如呼吸暫停癥狀緩解，則繼續(xù)治療2 d。觀察兩組患者臨床療效，同時比較治療前后兩組患者臨床癥狀改善情況、血漿β-內(nèi)啡肽（β-EP）、內(nèi)皮素（ET）、一氧化氮（NO）水平及智力發(fā)育指數(shù)（MDI）和運動發(fā)育指數(shù)（PDI）指數(shù)。結果 治療后，對照組和治療組臨床有效率分別為74.42%和93.02%，兩組比較差異具有統(tǒng)計學意義（P<0.05）。治療48 h后，兩組每日AOP發(fā)作次數(shù)均明顯減少（P<0.05），且治療組發(fā)作次數(shù)明顯少于對照組（P<0.05）。治療后，治療組用藥時間、AOP消失時間和給氧治療時間均明顯短于對照組（P<0.05）。治療后，兩組β-EP水平明顯降低（P<0.05），ET和NO水平明顯升高（P<0.05），且治療后治療組β-EP、ET、NO水平明顯優(yōu)于對照組（P<0.05）。治療后，兩組MDI和PDI指數(shù)均明顯升高（P<0.05），且治療組MDI和PDI指數(shù)均顯著高于對照組（P<0.05）。結論 咖啡因聯(lián)合洛貝林治療新生兒原發(fā)性AOP可有效調節(jié)患兒β-EP、ET、NO水平，促進腦神經(jīng)發(fā)育，療效顯著。

Objective To investigate the clinical efficacy of caffeine combined with lobeline in treatment of neonatal primary apnea (AOP). Methods Patients (86 cases) with primary apnea in Suizhou Central Hospital from February 2016 to June 2017 were randomly divided into control and treatment groups, and each group had 43 cases. Patients in the control group were intravenous injection administered with Lobeline Hydrochloride Injection, 0.3-3 mg/time, the interval time was 20-30 min for the next injection, and the cumulative dose was less than 20 mg/d. Patients in the treatment group were intravenous injection administered with Caffeine Citrate Injection alternate using with Lobeline Hydrochloride Injection, the initial dose was 20 mg/kg, maintained with 5 mg/kg after 24 h, and additional maintenance dose 10 mg/kg was administered according to the situation, once daily. Patients in two groups were treated for 5 d, if the apnea symptom was alleviated, then continued treatment for 2 d. After treatment, the clinical efficacy was evaluated, and the improvement of clinical symptoms, the plasma β-EP, ET and NO levels, the MDI and PDI indexes in two groups before and after treatment were compared. Results After treatment, the clinical efficacy in the control and treatment groups was 74.42% and 93.02%, respectively, and there were differences between two groups (P<0.05). After treatment for 48 h, the daily frequency of AOP in two groups was significantly decreased (P<0.05), and the frequency in the treatment group after treatment was significantly less than that in the control group (P<0.05). After treatment, the medication time, and disappearance time of AOP and oxygen treatment time in the treatment group after treatment was significantly shorter than that in the control group (P<0.05). After treatment, the β-EP levels in two groups were significantly decreased (P<0.05), but ET and NO levels were significantly increased (P<0.05), and the β-EP、ET and NO levels in the treatment group after treatment were significantly better than those in the control group (P<0.05). After treatment, the MDI and PDI indexes in two groups were significantly increased (P<0.05), and the MDI and PDI indexes in the treatment group after treatment were significantly higher than those in the control group (P<0.05). Conclusion Caffeine combined with lobeline in treatment of neonatal primary apnea can effectively regulate the β-EP, ET and NO levels, and promote the development of brain nerve with remarkable curative effect.