枸橼酸咖啡因联合加温湿化高流量鼻导管通气对呼吸窘迫综合征早产儿神经发育和血清BMP-7、CC16的影响

Effects of Caffeine Citrate Combined with Heated and Humidified High Flow Nasal Catheter Ventilation on Neurodevelopment,Serum BMP-7 and CC16 in Premature Infants with Respiratory Distress Syndrome

目的:观察枸橼酸咖啡因联合加温湿化高流量鼻导管通气(HHHFNC)对呼吸窘迫综合征(RDS)早产儿神经发育和血清骨形态发生蛋白-7(BMP-7)、Clara细胞分泌蛋白(CC16)的影响。方法:纳入2019年3月~2021年3月期间我院新生儿重症监护室收治的RDS早产儿93例,通过随机数字表法将患儿分为对照组[接受鼻持续气道正压通气(NCPAP)治疗]和实验组(接受枸橼酸咖啡因联合HHHFNC治疗),例数分别为46例、47例。对比两组患儿无创辅助通气时间、总用氧时间、撤机失败率、血气分析指标、神经发育指标、BMP-7、CC16水平和并发症情况。结果:实验组的无创辅助通气时间、总用氧时间短于对照组,撤机失败率低于对照组(P<0.05)。两组治疗24 h后pH值组间对比无统计学差异(P>0.05),实验组治疗24 h后血氧分压(PaO_(2))高于对照组,二氧化碳分压(PaCO_(2))低于对照组(P<0.05)。实验组治疗结束后精神运动发育指数(PDI)、智力发展指数(MDI)高于对照组,血清β-内啡肽(β-EP)水平低于对照组(P<0.05)。实验组治疗结束后血清BMP-7、CC16水平低于对照组(P<0.05)。两组患儿并发症发生率组间对比无统计学差异(P>0.05)。结论:枸橼酸咖啡因联合HHHFNC治疗早产儿RDS可缩短无创辅助通气时间,提高撤机成功率,促进氧合恢复,同时还可改善血清BMP-7、CC16水平,促进患儿神经发育。

Objective:To observe the effects of caffeine citrate combined with heating and humidifying high flow nasal catheter ventilation(HHHFNC)on neural development,serum bone morphogenetic protein-7(BMP-7)and Clara cell secretory protein(CC16)in premature infants with respiratory distress syndrome(RDS).Methods:93 premature infants with RDS who were treated in neonatal intensive care unit of our hospital from March 2019 to March 2021 were included.The children were randomly divided into control group[treated with nasal continuous positive airway pressure(nCPAP)]and experimental group(treated with caffeine citrate combined with HHHFNC),the number of cases were 46 and 47 respectively.The noninvasive auxiliary ventilation time,total oxygen consumption time,weaning failure rate,blood gas analysis index,neurodevelopment index,BMP-7,CC16 levels and complications were compared between the two groups.Results:The time of noninvasive auxiliary ventilation and total oxygen consumption in the experimental group were shorter than those in the control group,and the failure rate of weaning was lower than that in the control group(P<0.05).There was no significant difference in pH between the two groups 24 hours after treatment(P>0.05).24 hours after treatment,the partial pressure of blood oxygen(PaO_(2))in the experimental group was higher than that in the control group,and the partial pressure of carbon dioxide(PaCO_(2))was lower than that in the control group(P<0.05).After treatment,the psychomotor development index(PDI)and intellectual development index(MDI)in the experimental group were higher than those in the control group,β-Endorphins(β-EP)was lower than that in the control group(P<0.05).After treatment,the levels of serum BMP-7 and CC16 in the experimental group were lower than those in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).Conclusion:Caffeine citrate combined with HHHFNC in the treatment of RDS in preterm infants can shorten the time of noninvasive auxiliary ventilation,improve the success rate of weaning,promote the recovery of oxygenation,improve the levels of serum BMP-7 and CC16,and promote the neural development of children.