咖啡因在极／超低出生体重早产儿机械通气撤机中应用的临床疗效

Clinical effects of caffeine during weaning of mechanical ventilation in very/extreme low birth weight premature infants

目的探讨咖啡因在极/超低出生体重早产儿机械通气拔管撤机中应用的临床疗效。方法选择2013年1月至2014年12月本院新生儿科新生儿重症监护病房收治的生后早期机械通气的极/超低出生体重早产儿进行回顾性分析。2013年所有早产儿撤机前未应用枸橼酸咖啡因，撤机后应用经鼻持续气道正压通气（nasal continuous positive airway pressure，NCPAP），设为对照组；2014年所有早产儿撤机前24 h开始应用枸橼酸咖啡因，撤机后应用NCPAP，设为观察组。比较两组患儿撤机成功率、住院天数、无创辅助通气时间、用氧时间及相关并发症发生率。结果对照组和观察组各纳入50例，两组患儿性别、胎龄、出生体重、新生儿呼吸窘迫综合征病情、机械通气时间、母亲产前应用糖皮质激素及存在宫内感染高危因素比例等差异均无统计学意义（P〉0.05）；观察组撤机成功率高于对照组（96.0%比82.0%），住院天数、无创辅助通气时间、用氧时间短于对照组[（49.7±2.3） d比（56.4±2.1） d，（9.1±0.9） d比（12.2±1.2） d，（23.1±1.9） d比（32.8±2.5） d]，支气管肺发育不良发生率低于对照组（40.0%比62.0%），差异均有统计学意义（P〈0.05）；两组喂养不耐受和坏死性小肠结肠炎发生率差异无统计学意义（P〉0.05）。结论机械通气的极/超低出生体重早产儿撤机前24 h开始应用咖啡因并联合撤机后NCPAP，较单独应用NCPAP可提高撤机成功率，降低支气管肺发育不良发生率，未增加喂养不耐受及坏死性小肠结肠炎发生率。

ObjectiveTo study the clinical effects of caffeine during weaning of mechanical ventilation in very/extreme low birth weight （VLBW/ELBW） premature infants.MethodFrom January 2013 to December 2014, VLBW/ELBW premature infants with early mechanical ventilation in the neonatal department of our hospital were enrolled in the retrospective study. The infants were assigned into control group （admitted in 2013） and observation group （admitted in 2014）. Infants in the observation group received caffeine citrate 24 hours before extubation, and the control group didn′t. Both groups were treated with nasal continuous positive airway pressure （NCPAP） after extubation. The success rate of weaning, duration of hospital stay, duration of non-invasive assisted ventilation, duration of oxygen application and the incidences of related complications were compared between the two groups.ResultA total of 100 cases were studied, including 50 cases in the control group and 50 in the observation group, respectively. No significant differences were found between the two groups in gender, gestational age, birth weight, neonatal respiratory distress syndrome severity, mechanical ventilation duration, prenatal glucocorticoid use and the proportion of high risk factors of intrauterine infection （P〉0.05）. The success rate of weaning in the observation group was higher than the control group （96.0% vs.82.0%）. Duration of hospital stay （49.7±2.3 days）, non-invasive ventilation duration （9.1±0.9 days）, and oxygen use （23.1±1.9 days） in the observation group were all shorter than the control group （56.4±2.1 days, 12.2±1.2 days, 32.8±2.5 days, respectively）. The incidence of bronchopulmonary dysplasia （BPD） was significantly lower than the control group （40.0% vs.62.0%, P〈0.05）. No significant differences were found in the incidences of feeding intolerance and necrotizing enterocolitis （NEC） between the two groups （P〉0.05）.ConclusionThe use of caffeine 24 hours before weaning in combination with NCPAP can improve the success rate of weaning, reduce the incidence of BPD without increasing the incidence of feeding intolerance and NEC in VLBW/ELBW infants with mechanical ventilation.