不同剂量咖啡因联合经鼻间歇正压通气治疗早产儿呼吸暂停的临床效果

Clinical Effect of Different Doses of Caffeine Combined with Nasal Intermittent Positive Pressure Ventilation in Treatment of Apnea of Prematurity

目的:分析不同剂量咖啡因联合经鼻间歇正压通气(NIPPV)治疗早产儿呼吸暂停的临床效果。方法:选取2021年3月—2023年11月泰安市妇幼保健院新生儿科收治的呼吸暂停早产儿82例作为研究对象,随机分为观察组和对照组,各41例。两组早产儿均接受NIPPV治疗,对照组给予低维持剂量咖啡因治疗,观察组给予高维持剂量咖啡因治疗。比较两组治疗效果、症状恢复情况、肺功能、动脉血气指标、不良反应。结果:观察组治疗总有效率高于对照组,差异有统计学意义(P=0.023)。观察组呼吸暂停次数少于对照组,呼吸暂停持续时间、症状消失时间、NIPPV使用时间、吸氧时间、住院时间均短于对照组,差异有统计学意义(P<0.001)。治疗前,两组潮气量、每分钟通气量、动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))比较,差异无统计学意义(P>0.05);治疗后,两组潮气量、每分钟通气量、PaO_(2)均高于治疗前,且观察组高于对照组,两组PaCO_(2)均低于治疗前,且观察组低于对照组,差异有统计学意义(P<0.05)。两组不良反应总发生率比较,差异无统计学意义(P=0.775)。结论:高维持剂量咖啡因联合NIPPV治疗早产儿呼吸暂停的临床效果较好,能够缩短治疗时间,减少呼吸暂停次数,改善肺功能和动脉血气指标,且安全性较高。

Objective:To analyze the clinical effect of different doses of caffeine combined with nasal intermittent positive pressure ventilation(NIPPV) in treatment of apnea of prematurity.Methods:A total of 82 premature infants with apnea who were admitted to Neonatology Department of Taian Maternity and Child Health Hospital from March 2021 to November 2023 were selected as the study subjects.They were randomly divided into observation group and control group with 41 cases in each group.Premature infants in both groups received NIPPV treatment,the control group was treated with low-maintenance-dose caffeine,and the observation group was treated with high-maintenance-dose caffeine.The treatment effect,symptom recovery,pulmonary function,arterial blood gas index,and adverse reactions were compared between the two groups.Results:The overall response rate in the observation group was higher than that in the control group,and the difference was statistically significant(P=0.023).The number of apnea in the observation group was lower than that in the control group,and the duration of apnea,the time of symptom disappearance,the time of NIPPV use,the time of oxygen inhalation,and the length of hospital stay in the observation group were shorter than those in the control group,and the difference was statistically significant(P<0.001).Before treatment,there was no significant difference in tidal volume,minute ventilation,arterial partial pressure of oxygen(PaO_(2)) and arterial partial pressure of carbon dioxide(PaCO_(2)) between the two groups(P>0.05).After treatment,tidal volume,minute ventilation and PaO_(2) in the two groups were higher than those before treatment,and these indexes in the observation group were higher than those in the control group,while the PaCO_(2) in the two groups was lower than that before treatment,and this index in the observation group was lower than that in the control group,with a statistically significant difference(P<0.05).There was no significant difference in the total incidence of adverse reactions between the two groups(P=0.775).Conclusion:The combination of high-maintenance-dose caffeine with NIPPV has a good clinical effect in the treatment of apnea of prematurity,and can shorten the treatment time,reduce the number of apnea,improve pulmonary function and arterial blood gas indexes,and has a high safety.