咖啡因联合无创呼吸支持治疗极低出生体重儿呼吸暂停的疗效观察  

Efficacy of caffeine combined with non-invasive respiratory support on the treatment of apnea in very low birth weight preterm infants

作　　者：蒲伟丛[1] 刘翠青[1] 

机构地区：[1]河北省儿童医院新生儿科,石家庄050031

出　　处：《中国小儿急救医学》2014年第8期497-500,共4页Chinese Pediatric Emergency Medicine

基　　金：河北省医学适用技术跟踪项目（GL2012013）

摘　　要：目的 比较咖啡因联合加温湿化高流量鼻导管通气（heated humidified high-flow nasal cannula,HHHFNC）与经鼻持续气道正压通气（nasal continuous positive airway pressure,nCPAP）治疗早产儿呼吸暂停的有效性和安全性.方法 将2013年9月至2014年3月在河北省儿童医院NICU住院,诊断为早产儿原发性呼吸暂停的极低出生体重儿80例,按照呼吸支持的模式采用随机数字表法随机分为HHHFNC组（39例）和nCPAP组（41例）,两组患儿均给予咖啡因治疗.比较两组患儿频繁呼吸暂停的发生率、需要气管插管的比例、氧暴露时间、无创辅助通气时间、喂养情况以及不良事件的发生率.结果 两组患儿在性别比、胎龄、日龄、出生体重等方面差异无统计学意义（P＞0.05）;两组患儿频繁呼吸暂停的发生率[15.4％ （6/39） vs 12.2％（5/41）]、需要气管插管的比例[17.9％ （7/39） vs 19.5％（8/41）]、氧暴露时间[（183.1 ±31.2）h vs （175.9 ±32.1）h]、无创辅助通气时间[（163.3 ±25.1）h vs（153.0±26.2）h]等方面差异均无统计学意义（P＞0.05）.HHHFNC组患儿腹胀[7.7％ （3/39） vs24.4％（10/41）]、鼻损伤[2.6％（1/39） vs 19.5％ （8/41）]、头部塑形发生率[0.0％ （0/39） vs 29.3％（12/41）]均低于nCPAP组（P＜0.05）,且HHHFNC组开奶日龄较nCPAP组提前[（67.5 ±19.1）h vs（96.3±18.7）h,P＜0.05],达到足量经口喂养时间缩短[（346.8±28.6）h vs（371.0 ±29.4）h,P＜0.05].结论 HHHFNC联合咖啡因治疗极低出生体重早产儿呼吸暂停和nCPAP组同样有效,且早产儿易耐受,不良反应少,是一种有效的无创呼吸支持模式.Objective To compare the efficacy and safety of caffeine combined with humidified high-flow nasal cannula（HHHFNC） and nasal continuous positive airway pressure（nCPAP） on the treatment of apnea in very low birth weight （VLBW） preterm infants.Methods Totally 80 VLBW preterm infants with neonatal apnea,who were enrolled in the NICU of Hebei Province Children Hospital from September 2013 to March 2014,were randomly assigned to either HHHFNC group（39 cases） or nCPAP group（41 cases） according to respiratory support mode by random number table method,both groups were given caffeine.The incidence of severe apnea,incidence of reintubation,oxygen exposure time,duration of non-invasive ventilation time,feeding conditions and incidence of adverse events were compared.Results There were no significant differences in male/female ratio,gestational age,age at randomization and birth weight between the two groups（P 〉0.05）.There were no significant differences in the incidence of severe apnea[15.4% （6/39） vs 12.2 % （5/41）],incidence of reintubation [17.9 % （7/39） vs 19.5 % （8/41）],oxygen exposure time [（183.1 ± 31.2） h vs （175.9 ± 32.1） h],duration of non-invasive ventilation time [（163.3 ± 25.1） h v s （153.0 ± 26.2） h] between the two groups （P 〉 0.05）.The occurrence of abdominal distention [7.7 % （3/39） vs 24.4% （10/41）],nasal trauma[2.6% （1/39） vs 19.5 % （8/41）],head shaping [0.0% （0/39）vs 29.3% （12/41）] during treatment were lower in HHHFNC group than those of nCPAP group （P 〈 0.05）.Age began feeding was earlier in HHHFNC group than nCPAP group [（67.5 ± 19.1） h vs （96.3 ± 18.7） h,P 〈 0.05],and day to full oral feeding was reduced in HHHFNC group than nCPAP group [（346.8±28.6） h vs （371.0 ±29.4）,P 〈0.05].Conclusion HHHFNC combined with caffeine is effective on the treatment of apnea in VLBW preterm infants,and easier to make newborn tolerated.HHHFNC is an effective non-invasive respiratory support mode with

关 键 词：极低出生体重儿 加温湿化高流量鼻导管通气 经鼻持续气道正压通气 呼吸暂停 咖啡因 

分 类 号：R722.6[医药卫生—儿科]