低侵入性肺表面活性物质联合咖啡因对无创高频辅助通气治疗早产ARDS患儿脑神经发育的影响

Effects of low-invasive pulmonary surfactant combined with caffeine on cranial nerve development of premature infants with ARDS treated with non-invasive high-frequency assisted ventilation

摘要:

目的 探讨低侵入性肺表面活性物质联合咖啡因对无创高频辅助通气治疗早产急性呼吸窘迫综合征（ARDS）患儿脑神经发育的影响。方法 选取2020年6月—2022年6月海南西部中心医院收治的84例接受无创高频辅助通气治疗的早产ARDS患儿，按随机数字表法分为研究组和对照组，每组42例。对照组给予低侵入性肺表面活性物质治疗，研究组给予低侵入性肺表面活性物质联合咖啡因治疗。比较两组患儿的呼吸机使用时间、用氧时长、住院时间，治疗48 h后的临床疗效，治疗前和治疗48 h后的动脉血氧分压差值、动脉血二氧化碳分压差值、吸入氧浓度差值、智力发展指数差值、精神运动发育指数差值；采用酶联免疫吸附试验测定血清β-内啡肽（β-EP）、谷胱甘肽过氧化物酶（GSH-Px）水平；比较两组并发症情况。结果 研究组呼吸机使用时间、用氧时长、住院时间均短于对照组（P <0.05）；研究组临床总有效率高于对照组（P <0.05）；研究组治疗前后动脉血氧分压差值、动脉血二氧化碳分压差值、吸入氧浓度差值均高于对照组（P <0.05）；研究组治疗前后智力发展指数差值和精神运动发育指数差值均高于对照组（P <0.05）；研究组治疗前后血清β-EP差值和GSH-Px差值均高于对照组（P <0.05）；两组患儿并发症发生率比较，差异无统计学意义（P >0.05）。结论 低侵入性肺表面活性物质联合咖啡因用于无创高频辅助通气治疗的早产ARDS患儿可以缩短治疗时间，改善神经发育，疗效确切，安全可靠。

Abstract:

Objective To investigate the impact of low-invasive pulmonary surfactant combined with caffeine on neurodevelopment in preterm infants with noninvasive high-frequency oscillatory ventilation (NHFOV) for the treatment of acute respiratory distress syndrome (ARDS).Methods A total of 84 preterm infants diagnosed with ARDS and undergoing noninvasive high-frequency oscillatory ventilation were enrolled from June 2020 to June 2022 at Hainan Western Central Hospital. The infants were randomly divided into a study group and a control group, with 42 infants in each group. The control group received low-invasive pulmonary surfactant treatment, while the study group received low-invasive pulmonary surfactant combined with caffeine. Respiratory outcomes, clinical efficacy after 48 hours of treatment, and various parameters, including arterial oxygen pressure difference, arterial carbon dioxide pressure difference, oxygen inhalation concentration difference, intelligence development index difference, and psychomotor development index difference, were compared between the two groups. Serum levels of β-endorphin (β-EP) and glutathione peroxidase (GSH-Px) were measured using enzyme-linked immunosorbent assay. The incidence of complications in both groups was also compared.Results The study group showed significantly shorter mechanical ventilation duration, oxygen therapy duration, and hospital stay compared to the control group (P < 0.05). The clinical total effective rate in the study group was higher than that in the control group (P < 0.05). The study group exhibited higher values in arterial oxygen pressure difference, arterial carbon dioxide pressure difference, and oxygen inhalation concentration difference before and after 48 hours of treatment compared to the control group (P < 0.05). Intelligence development index difference and psychomotor development index difference in the study group were higher than those in the control group before and after treatment (P < 0.05). Serum β-EP difference and GSH-Px difference in the study group were higher than those in the control group before and after treatment (P < 0.05). There was no statistically significant difference in the incidence of complications between the two groups (P > 0.05).Conclusion The use of low-invasive pulmonary surfactant combined with caffeine in preterm infants with ARDS undergoing noninvasive high-frequency oscillatory ventilation can reduce the duration of treatment, improve neurodevelopment, and provide effective and safe therapeutic outcomes.