不同通气方式联合枸橼酸咖啡因在超未成熟儿机械通气撤机中的应用研究*

Study on application of different ventilation methods in weaning of mechanical ventilation*

摘要:

目的 探讨不同通气方式联合枸橼酸咖啡因治疗超未成熟儿机械通气撤机中的临床疗效。方法 选择2017年1月—2019年6月广东省第二人民医院66例超未成熟儿作为研究对象，采用随机数字表法分为不同通气方式的3组：加温湿化高流量鼻导管通气组（HHFNC组）（20例）、经鼻持续正压通气组（NCPAP组）（22例）和同步经鼻间歇正压通气组（SNIPPV组）（24例）。3组均给予枸橼酸咖啡因治疗。比较3组血气分析、吸入氧浓度、氧疗时间、无创通气时间、开始肠内营养时间、住院时间及腹胀、颅内出血、低血压、心律失常发生率。结果 3组治疗前后pH、PO2、PaCO2及FiO2差值的比较，差异有统计学意义（P?<0.05）；进一步两两比较，NCPAP组和SNIPPV组pH、PO2、PaCO2及FiO2差值比较，差异无统计意义（P?>0.05）；HHFNC组pH、PO2、PaCO2及FiO2差值均高于NCPAP组和SNIPPV组（P?<0.05）。3组氧疗时间、无创通气时间、开始肠内营养时间及住院时间比较，差异有统计学意义（P?<0.05），NCPAP组、SNIPPV组氧疗时间、无创通气时间、开始肠内营养时间及住院时间比较，差异无统计学意义（P?>0.05），HHFNC组氧疗时间、无创通气时间、开始肠内营养时间及住院时间均短于NCPAP组、SNIPPV组（P?<0.05）。3组患儿中途均无排除及退出者。 3组患儿腹胀、颅内出血、气胸、BPD及总并发症比较差异无统计学意义（P?>0.05）；3组患儿撤机成功比较差异有统计学意义（P?<0.05），HHFNC组与SNIPPV组撤机成功比较差异无统计学意义（P?>0.05），HHFNC组撤机成功高于NCPAP组（P?<0.05）。结论 将HHFNC联合枸橼酸咖啡因用于超未成熟儿机械通气撤机中能提高患儿血气水平，缩短无创通气时间、氧疗时间、开始肠内营养时间及住院时间，未增加不良反应发生率，值得推广应用。

Abstract:

Objective To explore the clinical effects of different ventilation methods combined with citrate caffeine in the treatment of mechanically ventilated and withdrawed children in ultra-immature children. Methods From January 2017 to June 2019, 66 cases of super immature children in the Pediatric Department of the Second People's Hospital of Guangdong Province were selected as the target. The random number method was divided into heated humidified high flow nasal catheter assisted ventilation group (HHFNC group) (n?=?20 cases), nasal continuous positive airway pressure group (NCPAP group) (n?=?22 cases), simultaneous internasal intermittent positive pressure ventilation (SNIPPV group) (n?=?24 cases). 3 groups were given caffeine citrate treatment. Comparisons of the blood gas analysis, inhaled oxygen concentration, oxygen therapy time, noninvasive ventilation time, starting enteral feeding time, hospitalization time and complications of abdominal distension, intracranial hemorrhage, hypotension and arrhythmia in 3 groups were performed. Results The difference among the three groups before and after treatment of a certain index was statistically significant (P??0.05); the difference in pH, PO2 (mmHg), PaCO2 (mmHg), and FiO2 (%) in the HHFNC group were higher than those in the NCPAP group and the SNIPPV group (P??0.05). The oxygen therapy time, noninvasive ventilation time, starting enteral feeding time and hospitalization time after treatment in the HHFNC group were shorter than those in the NCPAP group and SNIPPV group (P??0.05). There was a statistically significant difference in the successful withdrawal of 3 groups (P??0.05), and the success rate in HHFNC group was higher than that in NCPAP group (P?