加温湿化高流量鼻导管吸氧联合咖啡因在早产儿呼吸窘迫综合征中的临床应用

Clinical application of warming,humidifying,high-flow nasal cannula and oxygen inhalation combined with caffeine in premature infants with respiratory distress syndrome

目的探讨加温湿化高流量鼻导管吸氧联合治疗胎龄<34周早产儿呼吸窘迫综合征(RDS)的临床疗效和并发症。方法选择2016年1月至2021年1月我科应用加温湿化高流量鼻导管吸氧治疗的胎龄<34周RDS早产儿,采用随机数字表法分为研究组(咖啡因联合加温湿化高流量鼻导管吸氧)和对照组(仅用加温湿化高流量鼻导管吸氧)。结果研究组共纳入36例,对照组共纳入31例。研究组无创通气时间[(187±48)h与(261±74)h,t=-4.893,P<0.01]、需氧时间[(15±5)d与(20±11)d,t=-2.024,P=0.047]、住院时间[(30±10)d与(36±11)d,t=-2.090,P=0.041]明显短于对照组,研究组Ⅲ~Ⅳ级颅内出血(2/36与8/31,χ^(2)=3.903,P=0.048)、支气管肺发育不良(3/36与9/31,χ^(2)=4.854,P=0.028)、坏死性小肠结肠炎(1/36与7/31,χ^(2)=4.472,P=0.034)均低于对照组(P<0.05),2组在出生后7 d内需气管插管率、第2剂肺表面活性物质应用、药物关闭的动脉导管开放、气漏、早产儿视网膜病等发生率和病死率差异均无统计学意义(P>0.05)。结论应用咖啡因联合加温湿化高流量鼻导管吸氧治疗胎龄<34周早产儿呼吸窘迫综合征可缩短无创通气时间、需氧时间、住院时间,Ⅲ~Ⅳ级颅内出血、支气管肺发育不良、坏死性小肠结肠炎等并发症发生率,值得临床推广。

Objective To investigate the clinical efficacy and complications of the combined treatment on respiratory distress syndrome(RDS)in premature infants with a gestational age of less than 34 weeks with warming,humidifying,high-flow nasal catheter and oxygen inhalation.Methods From January 2016 to January 2021,67 premature infants with gestational age<34 weeks RDS who were treated with warmed,humidified,high-flow nasal catheter and oxygen inhalation in our department were selected and divided into study groups(n=36)by random number table(caffeine combined with warming,humidified high-flow nasal cannula for oxygen inhalation)and the control group(only heated and humidified high-flow nasal cannula for oxygen inhalation,n=31).Results The noninvasive ventilation time[(187±48)h vs(261±74)h,t=-4.893,P<0.01],aerobic time[(15±5)d与(20±11)d,t=-2.024,P=0.047],and hospital stay[(30±10)d vs(36±11)d,t=-2.090,P=0.041]of study group were significantly shorter than those of the con-trol group(P<0.05).The gradeⅢ-Ⅳintracranial hemorrhage(2/36 vs 8/31,χ^(2)=3.903,P=0.048),bronchopulmonary dysplasia(3/36 vs 9/31,χ^(2)=4.854,P=0.028),and necrotizing enterocolitis(1/36 vs 7/31,χ^(2)=4.472,P=0.034)of study group were all lower than those of con-trol group(P<0.05).There was no significant difference in the incidence and mortality of the two groups in the need for tracheal intubation within 7 days after birth,the second dose of pulmonary surfactant application,the opening of the drug-closed arterial duct,air leakage,and retinopathy of prematurity(P>0.05).Conclusion The use of caffeine combined with warming,humidifying,high-flow nasal catheter and oxygen in-halation for the treatment of RDS in preterm infants with gestational age<34 weeks can shorten the time of noninva-sive ventilation,aerobic time,hospital stay,as well as reduce gradeⅢ-Ⅳintracranial hemorrhage,bronchopulmonary dysplasia,necrotizing enterocolitis and other complications.It is worthy of clinical promotion.