不同剂量咖啡因联合NIPPV干预对ARDS早产儿撤机成功率、脑发育及神经预后的影响比较

Comparison of the effects of different doses of caffeine combined with NIPPV intervention on the success rate of weaning,brain development and neurological prognosis in premature infants with ARDS

目的分析急性呼吸窘迫综合征(ARDS)早产儿撤机后不同剂量咖啡因联合经鼻间歇正压通气(NIPPV)干预对撤机成功率、脑发育及神经预后的影响。方法选取广东医科大学顺德妇女儿童医院(佛山市顺德区妇幼保健院)新生儿科2023年1月~2023年12月收治的86例ARDS早产儿为研究对象,根据随机数字表法分为两组。对照组(43例)采用常规剂量[5 mg/(kg·d)]咖啡因联合NIPPV治疗,研究组(43例)采用大剂量[10 mg/(kg·d)]咖啡因联合NIPPV治疗。比较两组患者撤机疗效、血气分析指标、并发症、头颅MRI检查情况以及脑损伤状况、早期运动发育情况、智力指数。结果治疗前两组PaCO_(2)、PaO_(2)、FiO_(2)无明显差异(P>0.05);治疗前后两组pH无明显差异(P>0.05);治疗后研究组PaCO_(2)、FiO_(2)低于对照组,PaO_(2)高于对照组(P<0.05);治疗前,两组头颅MRI检查T1值、T2值、DWI值差异无统计学意义(P>0.05);治疗后研究组T1值、T2值、DWI值低于对照组(P<0.05);研究组撤机成功率高于对照组,机械通气时间、给氧时间少于对照组(P<0.05);两组并发症发生情况无明显差异(P>0.05);治疗前两组NBNA、Infanib、MDI、PDI评分无明显差异(P>0.05),治疗后研究组NBNA、Infanib、MDI、PDI评分高于对照组(P<0.05)。结论大剂量咖啡因联合NIPPV对ARDS早产儿撤机后干预效果更好,可提高撤机成功率,改善患儿氧合情况,减轻患儿脑损伤程度,改善患儿智力、运动发育情况,且具有与小剂量咖啡因治疗相似的安全性。

Objective To analyze the effects of different doses of caffeine combined with nasal intermittent positive pressure ventilation(NIPPV)intervention on the success rate of weaning,brain development and neurological prognosis in premature infants with acute respiratory distress syndrome(ARDS).Methods A total of 86 premature infants with ARDS admitted to the Shunde Women and Children's Hospital of Guangdong Medical University(Maternity&Child Healthcare Hospital of Shunde Foshan)from January 2023 to December 2023 were selected as the research objects and divided into two groups according to random number table method.The control group(43 cases)was treated with conventional dose[5 mg/(kg·d)]caffeine combined with NIPPV,and the study group(43 cases)was treated with high dose[10 mg/(kg·d)]caffeine combined with NIPPV.The efficacy of weaning effect,blood gas analysis indexs,complications,cranial MRI examination,brain injury status,early motor development and intelligence index were compared between the two groups.Results There were no significant differences in PaCO_(2),PaO_(2) and FiO_(2) between the two groups before treatment(P>0.05).There was no significant differences in pH between the two groups before and after treatment(P>0.05).After treatment,PaCO_(2) and FiO_(2) in the study group were lower than those in the control group,and PaO_(2) was higher than those in the control group(P<0.05).Before treatment,there was no statistically significant difference in T1,T2,and DWI values between the two groups of cranial MRI examination(P>0.05).After treatment,the T1,T2 and DWI values of the study group were lower than those of the control group(P<0.05).The success rate of weaning in the study group was higher than that in the control group,and the time of mechanical ventilation and oxygen supply time was less than that in the control group(P<0.05).There was no significant difference in the incidence of complications between the two groups(P>0.05).There was no significant difference in the scores of NBNA,Infanib,MDI and PDI between the two groups before treatment(P>0.05).After treatment,the scores of NBNA,Infanib,MDI and PDI in the study group were higher than those in the control group(P<0.05).Conclusion High dose caffeine combined with NIPPV has a better intervention effect on ARDS premature infants after weaning,which can improve the success rate of weaning,improve the oxygenation status of the children,reduce the degree of brain injury,improve the intelligence and motor development of the children,and has similar safety to low dose caffeine treatment.