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

付杰; 魏广友; 郑爱华; 刘军; 随素敏; 刘金广

doi:10.16766/j.cnki.issn.1674-4152.002946

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

doi: 10.16766/j.cnki.issn.1674-4152.002946

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

基金项目:

白求恩医学科学研究基金资助项目 SCE158NE

详细信息

通讯作者:
魏广友, E-mail: 13515682626@163.com

中图分类号: R722.6
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- 被引次数: 0
出版历程
- 收稿日期: 2022-04-21
- 网络出版日期: 2023-05-31

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

NICU, Bozhou People ' s Hospital of Anhui Medical University, Bozhou, Anhui 236800, China

摘要

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。
- 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
Abstract: 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.
- Nasal intermittent positive pressure ventilation /
- Caffeine citrate /
- Apnea of prematurity /
- Curative effect analysis

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表 1 2组早产儿一般情况比较

Table 1. Comparison of general conditions between two groups of premature infants

组别	例数	性别(例)		体重(x±s，g)	胎龄(x±s，周)	出生Apgar评分(x±s，分)
组别	例数	男	女	体重(x±s，g)	胎龄(x±s，周)	1 min	5 min
观察组	48	29	19	1 423.8±228.3	31.11±1.45	6.48±2.17	7.19±1.68
对照组	48	26	22	1 497.0±210.2	31.67±1.48	6.56±2.10	7.14±1.50
统计量		0.383^a		1.634^b	1.873^b	0.184^b	0.154^b
P值		0.536		0.102	0.064	0.849	0.898
注：^a为χ²值，^b为t值。

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表 2 2组早产儿各项指标比较

Table 2. Comparison of various indicators between two groups of premature infants

组别	例数	有创通气时间[M(P₂₅,P₇₅)，d]	无创通气时间(x±s，d)	拔管失败[例(%)]	吸氧时间[M(P₂₅,P₇₅)，d]	严重呼吸暂停[例(%)]	达全肠道喂养时间(x±s，d)	住院时间(x±s，d)
观察组	48	5.0(2.0,7.0)	4.34±1.74	4(8.3)	8.5(6.0，12.5)	3(6.3)	14.92±5.61	18.0(14.3，28.0)
对照组	48	4.5(2.0，7.0)	5.27±2.46	11(22.9)	8.0(6.0，17.8)	10(20.8)	16.67±5.96	17.5(15.0，23.8)
统计量		0.004^a	2.138^b	3.872^c	0.224^a	4.198^c	1.481^b	0.246^a
P值		0.997	0.035	0.049	0.822	0.038	0.142	0.806
注：^a为Z值，^b为t值,^c为χ²值。

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表 3 2组早产儿不良反应发生情况比较[例(%)]

Table 3. Comparison of the occurrence of adverse reactions between two groups of premature infants [cases(%)]

组别	例数	IVH	喂养不耐受	NEC	BPD	ROP	心动过速
研究组	48	12(25.0)	9(18.8)	4(8.3)	10(20.8)	5(10.4)	16(33.3)
对照组	48	14(29.2)	10(20.8)	5(10.4)	13(27.1)	7(14.6)	15(31.3)
χ²值		0.211	0.066	0.123	0.515	0.381	0.048
P值		0.646	0.798	0.726	0.473	0.537	0.827

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