枸橼酸咖啡因联合无创呼吸支持模式治疗新生儿重症吸入性肺炎的临床疗效及安全性

Clinical Efficacy and Safety of Caffeine Citrate Combined with Noninvasive Respiratory Support in the Treatment of Neonatal Severe Aspiration Pneumonia

【目的】探讨枸橼酸咖啡因联合无创呼吸支持模式治疗新生儿重症吸入性肺炎的临床疗效及安全性。【方法】前瞻性选择2018年6月至2020年4月本院收治的70例重症吸入性肺炎新生儿,根据随机数字表法将其分为观察组(枸橼酸咖啡因联合经鼻持续呼吸道正压通气,n=34)和对照组(枸橼酸咖啡因联合经鼻同步间歇正压通气,n=36)。对比两组肺功能指标、呼吸力学指标及血清胰岛素样生长因子结合蛋白-3(IGFBP-3)、β-内啡肽(β-EP)水平,并比较并发症发生情况。【结果】治疗后,两组潮气量(TV)、达峰时间比(TPTEF/TE)、达峰容积比(VPEF/VE)、呼气峰流速(PEF)均高于治疗前(P<0.05),呼吸频率(RR)、功能残气量(FRC)、有效气道阻力(RAW)均低于治疗前(P<0.05),且观察组与对照组比较差异均有统计学意义(P<0.05);两组患儿氧合指数、肺顺应性较治疗前均增大(P<0.05),吸气阻力较治疗前均减小(P<0.05),且观察组与对照组比较差异均有统计学意义(P<0.05);两组血清IGFBP-3水平高于治疗前,β-EP水平低于治疗前(P<0.05),且观察组与对照组比较差异均有统计学意义(P<0.05)。两组并发症发生率比较,差异无统计学意义(P>0.05)。【结论】枸橼酸咖啡因联合无创呼吸支持模式治疗新生儿重症吸入性肺炎,可改善患儿肺功能指标、呼吸力学指标,调节血清IGFBP-3、β-EP水平,但经鼻同步间歇正压通气优于经鼻持续呼吸道正压通气。

【Objective】To investigate the clinical efficacy and safety of caffeine citrate combined with noninvasive respiratory support in the treatment of neonatal severe aspiration pneumonia.【Methods】A total of 70 newborns with severe aspiration pneumonia treated in our hospital from June 2018 to April 2020 were prospectively selected and randomly divided into observation group(caffeine citrate combined with nasal continuous positive airway pressure ventilation,n=34)and control group(caffeine citrate combined with nasal synchronous intermittent positive pressure ventilation,n=36).The indexes of pulmonary function,respiratory mechanics and serum insulin-like growth factor binding protein-3(IGFBP-3)andβ-Endorphins(β-EP)were compared between the two groups,and the incidence of complications were also compared.【Results】After treatment,tidal volume(TV),peak time ratio(TPTEF/TE),peak volume ratio(VPEF/VE)and peak expiratory flow rate(PEF)in the two groups were higher than those before treatment(P<0.05),respiratory rate(RR),functional residual capacity(FRC)and effective airway resistance were lower than those before treatment(P<0.05),and there were significant differences between the observation group and the control group(P<0.05);The oxygenation index and lung compliance of the two groups were higher than those before treatment(P<0.05),and the inspiratory resistance was lower than that before treatment(P<0.05).There was significant difference between the observation group and the control group(P<0.05);The level of serum IGFBP-3 in the two groups was higher than that before treatment,and the level ofβ-EP was lower than that before treatment(P<0.05),and there was significant difference between the observation group and 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 noninvasive respiratory support model in the treatment of neonatal severe aspiration pneumonia can improve the indexes of pulmonary function and respiratory mechanics,and regulate serum IGFBP-3 andβ-EP level,but transnasal synchronous intermittent positive pressure ventilation is better than transnasal continuous positive airway pressure ventilation.