咖啡因在早产儿机械通气中效果的临床研究  

A clinical study on the efficacy of caffeine in premature infants receiving mechanical ventilation

作　　者：耿晓萌 刘俊丽[1] 李桂芳[1] 姚国[1] 张承芳[1] 史宝海[1] 

机构地区：[1]泰安市中心医院新生儿科,271000

出　　处：《中华新生儿科杂志（中英文）》2017年第6期443-447,共5页Chinese Journal of Neonatology

摘　　要：目的 探讨咖啡因在早产儿机械通气中的临床疗效及对相关并发症的影响.方法选取2014年1月至2016年9月本院新生儿重症监护病房收治的胎龄28-32周需经鼻持续气道正压通气（nasal continuous positive airway pressure,NCPAP）的早产儿和需常频机械通气（conventional mechanical ventilation,CMV）的极低出生体重早产儿,分别随机分为咖啡因组和对照组.咖啡因组早产儿分别在行NCPAP辅助通气时或CMV通气方式调整为同步间歇指令通气（synchronized intermittent mandatory ventilation,SIMV）模式时,即刻给予枸橼酸咖啡因;对照组静脉输注等量5%葡萄糖.采用t检验、χ^2检验对各组早产儿在机械通气中的临床疗效及相关并发症进行分析.结果研究期间共纳入需行NCPAP早产儿96例,出生体重1300-2100 g,其中咖啡因组51例,对照组45例;CMV早产儿84例,出生体重1000-1499 g,其中咖啡因组43例,对照组41例.NCPAP组早产儿通气时联合使用咖啡因撤机失败率和支气管肺发育不良发生率均低于对照组（0%比13.3%,3.9%比17.8%）,辅助通气时间和住院时间短于对照组[（6.2±3.1）d比（8.2±3.2）d、（16.3±8.7）d比（19.5±9.2）d],差异均有统计学意义（P〈0.05）;CMV组早产儿通气过程中由A/C模式调整为SIMV模式时联合使用咖啡因撤机失败率和支气管肺发育不良发生率同样低于对照组,机械通气时间和住院时间短于对照组,差异有统计学意义（P〈0.05）.两种机械通气方式下各组早产儿相关并发症比较差异均无统计学意义（P〉0.05）.结论NCPAP通气方式及CMV通气方式调整为SIMV模式联合使用咖啡因均可降低撤机失败率和支气管肺发育不良的发生率,且能够缩短机械通气时间和住院时间.Objective To study the clinical efficacy of caffeine in premature infants receiving mechanical ventilation and related complications .Method From January 2014 to September 2016, preterm infants （28w≤GA〈33w） treated with nasal continuous positive airway pressure （NCPAP） or conventional mechanical ventilation （ CMV ） in neonatal intensive care unit were studied .They were randomly assigned into the caffeine group and the control group .The caffeine group received caffeine when NCPAP ventilation was applied or adjusting to synchronized intermittent mandatory ventilation （ SIMV） mode.The control group was injected with 5%glucose without caffeine .The t test andχ^2 test were used to analyze the clinical efficacy and related complications .Result A total of 96 patients receiving NCPAP ventilation were collected （ birth weight between 1300-2100 g）, including 51 cases in caffeine group and 45 cases in the control group. 84 cases received CMV ventilation （birth weight between 1000-1499 g）, with 43 cases in the caffeine group and 41 cases the control group.Among the NCPAP infants, the incidence of failure to withdraw ventilator （0% vs.13.3%） and the incidence of bronchopulmonary dysplasia （3.9% vs.17.8%） were lower in the caffeine group than the control group .The duration of assisted ventilation and hospital stay in the caffeine group were shorter than the control group [（6.2 ±3.1） d vs.（8.2 ±3.2） d, （16.3 ±8.7） d vs. （19.5 ±9.2） d], the differences were statistically significant （P〈0.05）.Among the CMV infants, the incidence of failure of A/C to SIMV mode transition and bronchopulmonary dysplasia were lower in the caffeine group than the control group and the duration of assisted ventilation and hospital stay were shorter . The differences were statistically significant （ P 〈0.05 ） . No differences were found in the related complications in each group （ P〉0.05） . Conclusion Caffeine can help reduce the incidences of withdrawal failure, bronchopulmo

关 键 词：咖啡因 连续气道正压通气 通气机 机械 支气管肺发育不良 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]