枸橼酸咖啡因维持治疗对呼吸窘迫综合征早产儿机械通气后过渡性撤机的影响

Effect of caffeine citrate maintenance therapy on weaning from invasive mechanical ventilation in premature infants with neonatal respiratory distress syndrome

摘要:

目的 探讨枸橼酸咖啡因维持治疗对呼吸窘迫综合征（NRDS）早产儿机械通气后过渡性撤机的影响。方法 选取2019年5月—2021年10月三二〇一医院收治的82例NRDS早产儿作为研究对象，有创机械通气撤机后将早产儿分为对照组（经鼻间隙正压通气+氨茶碱治疗）和观察组（经鼻间隙正压通气+枸橼酸咖啡因维持治疗），每组41例。对比两组早产儿撤机成功率和救治成功率。对比两组早产儿撤机后不同时刻（首次撤机即刻、撤机后48 h和撤机后72 h）血气指标［血氧分压（PaO₂）、二氧化碳分压（PaCO₂）］、呼吸力学指标［气道阻力和内源性呼气末正压（PEEPi）］及血清学指标［铁蛋白（SF）、促肾上腺皮质激素（ACTH）］。对比两组早产儿住院期间并发症发生情况。结果 观察组撤机成功率和救治成功率高于对照组（P <0.05）。两组早产儿首次撤机即刻、撤机后48 h、72 h的PaO₂、PaCO₂、气道阻力、PEEPi、SF、ACTH比较，经重复测量设计的方差分析，结果 ①不同时间点PaO₂、PaCO₂、气道阻力、PEEPi、SF、ACTH有差异（P <0.05）；②两组早产儿PaO₂、PaCO₂、气道阻力、PEEPi、SF、ACTH有差异（P <0.05），观察组血气指标改善效果较好；③两组早产儿PaO₂、PaCO₂、气道阻力、PEEPi、SF、ACTH变化趋势有差异（P <0.05）。观察组住院期间并发症总发生率低于对照组（P <0.05）。结论 在NRDS早产儿撤机后采用枸橼酸咖啡因维持治疗可提高撤机成功率和救治成功率，改善血气分析指标、呼吸力学指标及血清学指标，降低并发症发生率。

Abstract:

Objective To investigate the effect of caffeine citrate maintenance therapy on weaning from invasive mechanical ventilation in premature infants with neonatal respiratory distress syndrome (NRDS).Methods A total of 82 premature infants with NRDS who were admitted to our hospital from May 2019 to October 2021 were selected. After weaning from invasive mechanical ventilation, they were divided into the control group (treated with nasal intermittent positive pressure ventilation and aminophylline) and observation group (treated with nasal intermittent positive pressure ventilation and caffeine citrate maintenance therapy), with 41 cases in each group. The success rates of weaning and rescue in the two groups were compared. The blood gas indexes [partial pressure of oxygen (PaO₂) and partial pressure of carbon dioxide (PaCO₂) ], respiratory mechanics parameters [airway resistance and intrinsic positive end-expiratory pressure (PEEPi) ] and serological indicators [ferritin (SF) and adrenocorticotropic hormone (ACTH) ] were compared. Besides, the incidence of complications during hospitalization in the two groups was also compared.Results The success rates of weaning and rescue in the observation group were higher than those in the control group (P < 0.05). The PaO₂ , PaCO₂, airway resistance, PEEPi, SF and ACTH immediately after first weaning and those at 48 h and 72 h after weaning in the two groups were compared via repeated measures analysis of variance. PaO₂ , PaCO₂ airway resistance, PEEPi, SF and ACTH were different among the time points (P < 0.05) and between the groups (P < 0.05), and the improvement in blood gas indexes was even better in the observation group. The change trends of PaO₂ , PaCO₂ airway resistance, PEEPi, SF and ACTH were also different between the two groups (P < 0.05). The overall incidence of complications during hospitalization in the observation group was lower than that in the control group (P < 0.05).Conclusions After weaning from invasive mechanical ventilation, caffeine citrate maintenance therapy can increase the success rates of weaning and rescue in premature infants with NRDS. Besides, it improves blood gas indexes, respiratory mechanics parameters, and serological indicators while reducing the incidence of complications.