呼吸机持续气道正压通气联合枸橼酸咖啡因治疗早产儿呼吸暂停给药时间与临床疗效的关系

目的:观察呼吸机持续气道正压通气支持下的不同枸橼酸咖啡因给药时间对早产儿呼吸暂停(AOP)疗效的影响。方法:选取91例出生胎龄<32周的原发性呼吸暂停患儿,按照枸橼酸咖啡因给药时间的不同将患儿分为早期组(51例,出生24 h内在呼吸机持续气道正压通气下完成枸橼酸咖啡因给药)和常规组(40例,72 h内在呼吸机持续气道正压通气下给予枸橼酸咖啡因治疗)。比较两组患儿的呼吸机应用时间、给药时间、吸氧天数以及呼吸暂停改善情况,记录呼吸指标变化和不良反应发生情况。结果:早期组呼吸机使用时间、给药时间、吸氧天数、3 d后呼吸暂停次数及住院时间均明显低于常规组,差异有统计学意义(t=5.561,t=2.901,t=2.821,t=3.180,t=2.987;P<0.05)。经枸橼酸咖啡因治疗3 d后,两组患儿β-内啡肽水平及二氧化碳分压较治疗前均有显著降低,且早期组较常规组下降更为明显(t=0.408,t=3.294;P<0.05);氧分压及血氧饱和度均较治疗前有显著回升,早期组较常规组升高更显著(t=6.4758,t=2.121,t=2.409;P<0.05)。早期组的治疗有效率为86.2%(44/51),常规组为72.5%(29/40),两组比较差异具有统计学意义(Z=-2.149,P<0.05)。早期组不良反应事件发生率为13.7%(7/51),常规组为15.0%(6/40),两组比较差异无统计学意义。结论:呼吸机持续气道正压通气可以改善患儿呼吸功能,有助于患儿更好的渡过呼吸暂停危险期,早期给予枸橼酸咖啡因可促进患儿更快的恢复,显著缩短治疗时间,但不会增加不良事件的发生。

The combined treatment of ventilator NCPAP and citric acid caffeine for AOP the relationship between medication time and clinical efficacy

Objective:To observe the effect of different medication time of citric acid caffeine on apnea of prematurity(AOP)of premature infant under the support of nasal continuous positive airway pressure(NCPAP)of ventilator.Methods:A total of 91 infants with primary apnea whose gestational age were less than 32 weeks were enrolled in the study.They were divided into early stage group and conventional group according to the different medication time of citric acid caffeine.The early stage group included 51 cases who completed the medication of citric acid caffeine under ventilator NCPAP within 24 hours post birth,and the conventional group included 40 cases who received the treatment of citric acid caffeine under ventilator NCPAP within 72 hours post birth.The application time of ventilator,the medication time,the number of the days of oxygen inhalation and the improvement of apnea between the two groups were compared,and the changes in respiratory indicators and the occurrences of adverse reactions were recorded.Results:The application time of ventilator,the medication time,the number of days of oxygen inhalation,the times of apnea after 3 days of treatment with citric acid caffeine and hospital stays of the early stage group were significantly lower than those of conventional group(t=5.561,t=2.901,t=2.821,t=3.180,t=2.987,P<0.05).The levels ofβ-endorphin and partial pressure of carbon dioxide in the two groups after 3 days of treatment with citric acid caffeine were significantly lower than those before treatment,and the decrease of early stage group was more significant than that of conventional group(t=0.408,t=3.294,P<0.05).And compared with oxygen partial pressure and blood oxygen saturation in two groups before treatment,those were significantly increased after treatment,and the increase of early stage group was significant higher than that of conventional group(t=6.4758,t=2.121,t=2.409,P<0.05).The effective rate was 86.2%(44/51)in early group and was 72.5%(29/40)in conventional group,respectively,and the difference of that between the two groups was significant(Z=-2.149,P<0.05).The incidence of adverse events was 13.7%(7/51)in early group and that was 15.0%(6/40)in conventional group,respectively,while the difference of that was not significantly.Conclusion:Ventilator NCPAP can improve the respiratory function of infant with primary apnea and help them to better live through the dangerous period of apnea.Early medication of citric acid caffeine can promote faster recovery and significantly shorten the treatment time,but does not increase the incidence of adverse events.