早产儿呼吸暂停采取NCPAP联合枸橼酸咖啡因治疗的临床效果分析

Analysis of clinical effect of NCPAP combined with caffeine citrate in the treatment of premature infants with apnea

目的 分析早产儿呼吸暂停通过持续气道正压通气(NCPAP)联合枸橼酸咖啡因进行治疗的临床效果。方法 110例呼吸暂停早产儿,根据治疗方式不同分为单纯NCPAP治疗组(37例)、单纯咖啡因治疗组(37例)、联合治疗组(36例)。单纯NCPAP治疗组使用单纯NCPAP治疗,单纯咖啡因治疗组使用单纯枸橼酸咖啡因治疗,联合治疗组采用NCPAP联合枸橼酸咖啡因治疗。对比三组患儿疗效、并发症发生率、临床指标、血气指标、肺功能指标、发育情况。结果 联合治疗组患儿总有效率为97.22%,高于单纯NCPAP治疗组的67.57%、单纯咖啡因治疗组的64.86%,差异具有统计学意义(P<0.05)。联合治疗组患儿并发症发生率为5.56%,低于单纯NCPAP治疗组的32.43%、单纯咖啡因治疗组的35.14%,差异具有统计学意义(P<0.05)。联合治疗组患儿住院时间(18.20±3.86)d、呼吸暂停时间(15.12±2.31)s/次短于单纯NCPAP治疗组的(24.69±5.67)d、(19.46±3.67)s/次和单纯咖啡因治疗组的(24.78±5.58)d、(19.56±3.78)s/次,呼吸暂停次数(1.15±0.14)次/d少于单纯NCPAP治疗组的(2.32±0.46)次/d和单纯咖啡因治疗组的(2.33±0.57)次/d,差异具有统计学意义(P<0.05)。治疗后,联合治疗组患儿动脉血二氧化碳分压(40.27±3.30)mm Hg(1 mm Hg=0.133 kPa)低于单纯NCPAP治疗组的(45.27±4.78)mm Hg、单纯咖啡因治疗组的(45.38±4.89)mm Hg,动脉血氧分压(78.32±6.87)mm Hg、pH值(7.42±0.05)高于单纯NCPAP治疗组的(69.85±5.46)mm Hg、(7.38±0.03)和单纯咖啡因治疗组的(69.85±5.47)mm Hg、(7.39±0.04),差异具有统计学意义(P<0.05)。治疗后,联合治疗组患儿运动评分(111.36±19.88)分、智力评分(113.68±18.53)分高于单纯NCPAP治疗组的(96.71±20.86)、(98.62±17.58)分和单纯咖啡因治疗组的(96.82±20.98)、(98.71±17.47)分,差异具有统计学意义(P<0.05)。联合治疗组患儿潮气量(8.58±1.68)ml/kg、达峰容积比(37.59±1.68)%、达峰时间比(36.38±1.55)%、每分通气量(0.78±0.29)L/(min·kg)、25%潮气量时呼气流速(36.88±1.36)ml/s、75%潮气量时呼气流速(36.78±1.49)ml/s均高于单纯NCPAP治疗组的(7.64±1.08)ml/kg、(33.06±1.51)%、(33.56±1.37)%、(0.47±0.16)L/(min·kg)、(32.11±1.62)ml/s、(34.13±1.25)ml/s和单纯咖啡因治疗组的(7.53±1.14)ml/kg、(33.04±1.42)%、(33.57±1.48)%、(0.49±0.27)L/(min·kg)、(32.22±1.73)ml/s、(34.26±1.36)ml/s,差异具有统计学意义(P<0.05)。结论 为呼吸暂停早产儿实施NCPAP联合枸橼酸咖啡因治疗,可以改善患儿临床指标,促进患儿神经发育,减少并发症,提升治疗效果,临床应用价值较高。

Objective To analyze the clinical effect of nasal continuous positive airway pressure(NCPAP)combined with caffeine citrate in the treatment of premature infants with apnea.Methods 110 premature infants with apnea were divided into NCPAP treatment group(37 cases),caffeine treatment group(37 cases)and combined treatment group(36 cases)according to different treatment methods.NCPAP treatment group was treated with simple NCPAP,caffeine treatment group was treated with simple caffeine citrate,and the combined treatment group was treated with NCPAP and caffeine citrate.The curative effect,incidence of complications,clinical indicators,blood gas indicators,lung function indicators,and development of the three groups were compared.Results The total effective rate of the combined treatment group was 97.22%,which was higher than 67.57%of the NCPAP group and 64.86%of the caffeine group,and the difference was statistically significant(P<0.05).The incidence of complications in the combined treatment group was 5.56%,which was lower than 32.43%in the NCPAP treatment group and 35.14%in the caffeine treatment group,and the difference was statistically significant(P<0.05).The hospitalization time and duration of apnea in the combined treatment group were(18.20±3.86)d and(15.12±2.31)s/time,which were shorter than those in the NCPAP treatment group[(24.69±5.67)d and(19.46±3.67)s/time]and the caffeine treatment group[(24.78±5.58)d and(19.56±3.78)s/time];the combined treatment group had number of apnea of(1.15±0.14)times/d,which was less than(2.32±0.46)times/d in the NCPAP treatment group and(2.33±0.57)times/d in the caffeine treatment group;the difference was statistically significant(P<0.05).After treatment,the combined treatment group had lower arterial partial pressure of carbon dioxide of(40.27±3.30)mm Hg(1 mm Hg=0.133 kPa),which was lower than(45.27±4.78)mm Hg in the NCPAP group and(45.38±4.89)mm Hg in the caffeine group;the combined treatment group had arterial partial pressure of oxygen of(78.32±6.87)mm Hg and pH of(7.42±0.05),which were higher than those of the NCPAP group[(69.85±5.46)mm Hg and(7.38±0.03)]and the caffeine group[(69.85±5.47)Hg and(7.39±0.04)];the difference was statistically significant(P<0.05).After treatment,the combined treatment group had motor score of(111.36±19.88)points and intelligence score of(113.68±18.53)points,which were higher than those in the NCPAP group[(96.71±20.86)and(98.62±17.58)]and the caffeine group[(96.82±20.98)and(98.71±17.47)].The difference was statistically significant(P<0.05).The combined treatment group had tidal volume of(8.58±1.68)ml/kg,ratio of the volume to peak expiratory flow and expiratory volume of(37.59±1.68)%,ratio of the time to peak expiratiry flow and expiratory time of(36.38±1.55)%,minute ventilation volume of(0.78±0.29)L/(min·kg),25%tidal volume expiratory flow rate of(36.88±1.36)ml/s,75%tidal volume expiratory flow rate of(36.78±1.49)ml/s,which were higher than those of the NCPAP group[(7.64±1.08)ml/kg,(33.06±1.51)%,(33.56±1.37)%,(0.47±0.16)L/(min·kg),(32.11±1.62)ml/s and(34.13±1.25)ml/s]and the caffeine group[(7.53±1.14)ml/kg,(33.04±1.42)%,(33.57±1.48)%,(0.49±0.27)L/(min·kg),(32.22±1.73)ml/s and(34.26±1.36)ml/s].The difference was statistically significant(P<0.05).Conclusion Implementing NCPAP combined with caffeine citrate therapy for premature infants with apnea can improve clinical indicators,promote development of children,reduce complications,and enhance treatment effect.It has high clinical application value.