咖啡因预防早产儿呼吸机相关性肺炎的作用

目的:分析咖啡因预防早产儿呼吸机相关性肺炎(ventilator-associated pneumonia,VAP)的作用,为有效制订治疗方案提供依据。方法:选取2018年1月至2019年12月108例新生儿呼吸窘迫综合征(neonatalresp irator yd i stresss y ndrome,NR DS)早产儿,采用随机数表法分为研究组和对照组,每组各54例。两组均在拔除气管插管后给予经鼻间歇正压通气(nasal intermittent positive pressure vent i lat ion,NI PP V)治疗,研究组同时给予静脉注射枸橼酸咖啡因,对照组同时给予静脉注射氨茶碱。对两组的VAP发生率、机械通气时间、住院时间、其他并发症发生率进行观察和比较;对两组首次拔管前、拔管后1 h、拔管后12 h的动脉血二氧化碳分压(Pa CO_2)、动脉血氧分压(par tial pressureofox ygen,Pa O_2)、p H值等血气指标进行监测。结果:研究组和对照组分别有3例和10例发生VAP,感染率分别为5.56%和18.52%,差异有统计学意义(P<0.05);两组动脉血p H值和Pa O_2水平均于拔管后逐渐上升,动脉血Pa CO_2水平于拔管后逐渐下降,在拔管后12 h,研究组动脉血p H值和Pa O_2水平高于对照组,动脉血Pa CO_2水平低于对照组,差异均有统计学意义(均P<0.05);研究组其他并发症总发生率、通气时间、住院时间均低于对照组,差异均有统计学意义(均P<0.05)。结论:对于NR DS早产儿,在NIPP V同时联合应用咖啡因治疗,可缩短机械通气时间、降低VAP发生率、改善患儿血氧水平、减少并发症的发生,疗效优于应用氨茶碱。

Effect of caffeine on prevention of ventilator-associated pneumonia in premature infants

Objective:To analyze the effects of caffeine in preventing ventilator-associated pneumonia(VAP)in premature infants to provide research basis for effective formulation of treatment plan.Methods:A total of 108 premature infants with neonatal respiratory distress syndrome(NRDS)from January of 2018 to December of 2019 were selected;they were divided into the study group and the control group by random number table method.54 cases were included in each group.The infants in the two groups were treated with nasal intermittent positive pressure ventilation(NIPPV)after tracheal extubations.At the same time,the infants in the study group were treated with intravenous injection of caffeine citrate,while the infants in the control group were treated with intravenous injection of aminophylline.The incidence of VAP,the mechanical ventilation time,the hospitalization time and the incidences of other complications between the two groups were observed and compared.Blood gas indexes such as the arterial partial pressure of carbon dioxide(PaCO2)levels,the arterial partial pressure of oxygen(PaO2)levels,and the pH values before the first extubation,1 hour after extubation,12 hours after extubation between the two groups were monitored.Results:There were 3 cases of VAP in the study group and 10 cases in the control group,and the infection rates were 5.56%and 18.52%respectively.The difference was statistically significant(P<0.05).The arterial blood pH value and PaCO2 levels of the infants in the two groups increased gradually after extubation,and the arterial blood PaCO2 levels decreased gradually after extubation.Twelve hours after extubation,the arterial blood pH value and PaO2 level of the children in the study group were higher than those in the control group,and the arterial blood PaCO2 was lower than that in the control group.The differences were statistically significant(P<0.05);the total incidences of other complications,the ventilation time,and the hospitalization time of the children in the study group were lower than those in the control group(P<0.05).Conclusion:For the premature infants with NRDS,treatment of NIPPV combined with caffeine can shorten the duration of mechanical ventilation,reduce the incidence of VAP,improve the blood oxygenation level and reduce complications.The curative effects are better than those of aminophylline.