经鼻间歇正压通气联合枸橼酸咖啡因治疗早产儿呼吸暂停疗效分析  

Effect of nasal intermittent positive pressure ventilation combined with caffeine citrate on apnea of prematurity

作　　者：付杰[1] 魏广友 郑爱华 刘军[1] 随素敏 刘金广 FU Jie;WEI Guangyou;ZHENG Aihua;LIU Jun;SUI Sumin;LIU Jinguang(NICU,Bozhou People's Hospital of Anhui Medical University,Bozhou,Anhui 236800,China)

机构地区：[1]安徽医科大学附属亳州医院亳州市人民医院NICU,安徽亳州236800

出　　处：《中华全科医学》2023年第4期626-628,645,共4页Chinese Journal of General Practice

基　　金：白求恩医学科学研究基金资助项目(SCE158NE)。

摘　　要：目的 探讨经鼻间歇正压通气(NIPPV)联合枸橼酸咖啡因治疗早产儿呼吸暂停(AOP)的疗效及安全性,明确AOP的最佳治疗方案,提高临床救治水平。方法 选取2019年10月—2021年7月亳州市人民医院NICU收治的96例AOP患儿,采用随机数字表法分为观察组(经鼻间歇正压通气+咖啡因)48例和对照组(经鼻持续气道正压通气+咖啡因)48例,比较2组患儿的疗效及不良反应发生率。结果 观察组严重呼吸暂停发生率、拔管失败率及无创通气时间分别为6.3%(3/48)、8.3%(4/48)、(4.34±1.74)d,较对照组[20.8%(10/48)、22.9%(11/48)、(5.27±2.46)d]明显下降,差异有统计学意义(均P<0.05)。观察组有创通气时间、吸氧时间、达全肠道喂养时间及住院时间分别为5.0(2.0,7.0)d、8.5(6.0,12.5)d、(14.92±5.61)d、18.0(14.3,28.0) d,与对照组[4.5(2.0,7.0)d、8.0(6.0,17.8)d、(16.67±5.96)d、17.5(15.0,23.8)d]比较差异均无统计学意义(均P>0.05)。观察组患儿脑室内出血(IVH)、喂养不耐受、新生儿坏死性小肠结肠炎(NEC)、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、心动过速等不良反应发生率与对照组比较差异均无统计学意义(均P>0.05)。结论 NIPPV联合枸橼酸咖啡因能够减少严重呼吸暂停发生率、拔管失败率及无创通气时间,且不增加不良反应的发生,是一种安全有效的AOP治疗方式。Objective To investigate the efficacy and safety of intermittent nasal positive pressure ventilation(NIPPV)combined with caffeine citrate in the treatment of premature apnea(AOP),and to clarify the best treatment plan of AOP,so as to improve the clinical treatment level.Methods A total of 96 children with AOP in NICU of Bozhou People's Hospital from October 2019 to July 2021 were selected and divided into observation group(48 cases,NIPPV+caffeine)and control group(48 cases,nasal continuous positive airway pressure+caffeine)by random number table method.The efficacy and incidence of adverse reactions of the two groups were compared.Results The incidence of severe apnea,extubation failure rate and non-invasive ventilation time in the observation group were 6.3%(3/48),8.3%(4/48)and(4.34±1.74)days,respectively,which were significantly lower than those in the control group[20.8%(10/48),22.9%(11/48)and(5.27±2.46)days],and the differences were statistically significant(all P<0.05).The duration of invasive ventilation,oxygen inhalation time,the time to reach the whole intestinal feeding and the hospital stay in the observation group were 5.0(2.0,7.0)days,8.5(6.0,12.5)days,(14.92±5.61)days,18(14.3,28.0)days,respectively,and there was no significant difference between the observation group and the control group[4.5(2.0,7.0)days,8.0(6.0,17.8)days,(16.67±5.96)days,17.5(15.0,23.8)days],all P>0.05.There was no significant difference in the incidence of adverse reactions such as intraventricular hemorrhage(IVH),feeding intolerance,neonatal necrotizing enterocolitis(NEC),bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP)and tachycardia between the two groups(all P>0.05).Conclusion NIPPV combined with caffeine citrate can reduce the incidence of severe apnea,extubation failure rate and non-invasive ventilation time without increasing the incidence of adverse reactions,which is a safe and effective treatment for AOP.

关 键 词：经鼻间歇正压通气 枸橼酸咖啡因 早产儿呼吸暂停 疗效分析 

分 类 号：R722.6[医药卫生—儿科]