早产儿出生后早期应用枸橼酸咖啡因联合维生素A、维生素D预防支气管肺发育不良的有效性研究

Effectiveness Analysis on Early Application of Caffeine Citrate Combined with Vitamin A and Vitamin D in the Prevention of Bronchopulmonary Dysplasia in Preterm Infants

目的:探讨早产儿出生后早期应用枸橼酸咖啡因联合维生素A、维生素D预防支气管肺发育不良(BPD)的有效性。方法:回顾性选择2021年12月至2023年6月该院收治的早产儿105例,根据产后治疗方式分为常规组(常规治疗,n=50)、预防组(常规治疗+枸橼酸咖啡因联合维生素A、维生素D预防,n=55)。比较两组早产儿BPD发生情况及分度,密切观察病情变化,比较颅内出血(ICH)、脑室周围白质软化(PVL)、败血病和视网膜病变(ROP)等并发症发生情况,记录并比较两组早产儿呼吸机使用时间、吸氧时间、恢复出生体重时间和住院时间。治疗48 h后,观察两组早产儿血气分析指标包括pH、动脉血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、氧合指数(OI)和吸氧浓度(FiO_(2))水平;比较治疗前后炎症指标肿瘤坏死因子α(TNF-α)、白细胞介素6(IL-6)水平变化。结果:预防组早产儿的BPD发生率明显低于常规组,BPD轻度早产儿所占比例明显高于常规组,差异均有统计学意义(P<0.05)。常规组与预防组早产儿高血压、气胸、坏死性小肠结肠炎、高血糖、动脉导管未闭、颅内出血和败血症的发生率比较,差异均无统计学意义(P>0.05)。预防组早产儿治疗后呼吸机使用时间、吸氧时间、恢复出生体重时间和住院时间明显短于常规组,差异均有统计学意义(P<0.05)。预防组早产儿治疗后PaO_(2)、OI水平明显高于常规组,PaCO_(2)、FiO_(2)水平明显低于常规组,差异均有统计学意义(P<0.05)。治疗后,两组早产儿血清TNF-α、IL-6水平较治疗前明显降低,预防组早产儿明显低于常规组,差异均有统计学意义(P<0.05)。结论:早产儿出生后早期应用枸橼酸咖啡因联合维生素A、维生素D可预防BPD发生及降低BPD严重程度,其机制可能与改善早产儿呼吸功能、降低机体炎症有关。另外,早期应用枸橼酸咖啡因联合维生素A、维生素D还可降低ICH、PVL、败血病和ROP等其他并发症的发生,有助于改善早产儿预后情况。

OBJECTIVE:To explore the effectiveness of the early application of caffeine citrate combined with vitamin A and vitamin D in the prevention of broncho-pulmonary dysplasia(BPD)in preterm infants.METHODS:A total of 105 premature infants admitted into this hospital from Dec.2021 to Jun.2023 were retrospectively selected to be divided into the convention group(conventional treatment,50 cases)and prevention group(conventional treatment+caffeine citrate combined with vitamin A and vitamin D for prevention,55 cases)according to different postpartum treatment.The occurrence and grading of BPD were compared between two groups and the changes of illness condition were closely observed,the incidences of intracranial hemorrhage(ICH),periventricular leukomalacia(PVL),sepsis and retinopathy(ROP)were compared,the duration of ventilator use and oxygen uptake,recovery time of birth weight and length of hospital stay of the two groups were recorded and compared.After 48 h of treatment,the indicators of arterial blood gas analysis including pH,arterial partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI)and fraction of inspired oxygen(FiO_(2))levels of both groups were observed;the changes of inflammatory indicators of tumor necrosis factorα(TNF-α)and interleukin 6(IL-6)levels were compared between two groups before and after treatment.RESULTS:The incidence of BPD was significantly lower and the proportion of mild BPD was significantly higher in the prevention group than those in the convention group,with statistically significant differences(P<0.05).There were no statistically significant differences in the incidence of hypertension,pneumothorax,necrotizing enterocolitis,hyperglycemia,patent ductus arteriosus,intracranial hemorrhage,and sepsis between the control group and the prevention group in premature infants(P>0.05).The duration of ventilator use and oxygen uptake,recovery time of birth weight and length of hospital stay of the prevention group after treatment were significantly shorter than those of the convention group,with statistically significant differences(P<0.05).The PaO_(2)and OI levels were significantly higher,the PaCO_(2)and FiO_(2)were significantly lower in the prevention group than those in the convention group,with statistically significant differences(P<0.05).After treatment,the serum TNF-αand IL-6 levels of both groups had been significantly decreased compared to before treatment,and that of the prevention group was significantly lower than the convention group,with statistically significant difference(P<0.05).CONCLUSIONS:The early application of caffeine citrate combined with vitamin A and vitamin D can prevent the occurrence of BPD and reduce the severity of BPD,its mechanism may related to improving respiratory function and reducing body inflammation in preterm infants.In addition,early application of caffeine citrate combined with vitamins A and vitamin D may also reduce other complications such as ICH,PVL,sepsis and ROP,which is helpful to improve the prognosis of preterm infants.