枸橼酸咖啡因联合NIPPV对早产儿呼吸暂停患儿血气指标及预后的影响

刘波

【摘要】 目的：觀察枸橼酸咖啡因、经鼻间歇正压通气（NIPPV）联合治疗对早产儿呼吸暂停（AOP）患儿血气指标及预后的影响。方法：回顾性分析2017年1月-2019年2月笔者所在医院治疗的150例AOP患儿临床资料，依据治疗方法的不同将其分为两组，将接受NIPPV治疗的70例AOP患儿临床资料组成对照组，将接受枸橼酸咖啡因与NIPPV联合治疗的80例AOP患儿临床资料组成观察组。观察两组临床疗效、NIPPV使用时间、住院时间、血气指标[动脉二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）]及支气管肺发育不良（BPD）发生情况。结果：观察组有效率（91.25%）高于对照组（80.00%），BPD发生率（3.75%）低于对照组（14.29%），NIPPV使用时间（4.60±1.17）d、住院时间（31.63±2.92）d，均短于对照组的（6.04±1.23）d、（35.97±3.10）d，差异有统计学意义（P<0.05）;治疗前两组PaCO2、PaO2水平对比，差异无统计学意义（P>0.05）;治疗后观察组PaCO2（42.13±6.24）mm Hg，低于对照组的（46.31±6.07）mm Hg，PaO2（72.43±6.52）mm Hg，高于对照组的（63.75±6.09）mm Hg，差异有统计学意义（P<0.05）。结论：AOP患儿接受枸橼酸咖啡因、NIPPV联合治疗有助于改善血气指标，缩短NIPPV使用时间，降低BPD发生率，加快患儿恢复，改善预后。

【关键词】 早产儿呼吸暂停 枸橼酸咖啡因 经鼻持续气道正压通气 血气指标 预后

doi：10.14033/j.cnki.cfmr.2020.01.059 文献标识码 B 文章编号 1674-6805（2020）01-0-03

[Abstract] Objective： To observe the effects of combination of caffeine citrate and nasal intermittent positive pressure ventilation （NIPPV） on blood gas index and prognosis in children with premature infants with apnea （AOP）. Method： The clinical data of 150 children with AOP treated in our hospital from January  2017 to February 2019 were retrospectively analyzed. According to the different treatment methods， the clinical data were divided into two groups. The clinical data of 70 children with AOP who received NIPPV treatment were composed. The clinical data of 80 patients with AOP who were treated with Citrate Caffeine and NIPPV were included in the observation group. The clinical efficacy， NIPPV use time， hospitalization time， blood gas index [arterial carbon dioxide partial pressure （PaCO2）， arterial oxygen partial pressure （PaO2）] and bronchopulmonary dysplasia （BPD） were observed. Result： The effective rate of the observation group （91.25%） was higher than that of the control group （80.00%）， the incidence of BPD （3.75%） was lower than that of the control group （14.29%）， the time of NIPPV was （4.60±1.17） d， and the length of hospital stay （31.63±2.92） d， both were shorter than the control groups （6.04±1.23） d， （35.97±3.10） d， the difference was statistically significant （P<0.05）. There was no significant difference in the levels of PaCO2 and PaO2 between the two groups before treatment （P>0.05）. PaCO2 was （42.13±6.24） mm Hg  in the observation group after treatment， which was lower than the control groups （46.31±6.07） mm Hg， PaO2 was （72.43±6.52） mm Hg， higher than the control groups （63.75±6.09） mm Hg. The differences were statistically significant （P<0.05）. Conclusion： The combination of Caffeine Caffeine and NIPPV in children with AOP can improve blood gas index， shorten the time of NIPPV， reduce the incidence of BPD， accelerate the recovery of children and improve the prognosis.

[Key words] Premature infant apnea Citrate Caffeine Nasal continuous positive airway pressure Blood gas index Prognosis

First-authors address： Ezhou Maternal and Child Health Hospital， Ezhou 436000， China

早产儿多是指于妊娠年龄<37周的婴儿，呼吸暂停（apnea of prematurity，AOP）作为早产儿常见并发症，新生儿多表现有呼吸停止>20 s，且出现心动过缓、肌张力减退、皮肤苍白或青紫症状[1]。经鼻间歇正压通气（nasal intermittent positive pressure ventilation，NIPPV）以无创形式模拟间歇机械通气，为AOP治疗中常用方法[2]。咖啡因属于甲基黄嘌呤类药物，利于改善呼吸中枢吸气作用，改善呼吸抑制[3]。鉴于此，本研究将观察联合枸橼酸咖啡因、NIPPV治疗对AOP患儿血气指标及预后的影响。现报告如下。

1 资料与方法

1.1 一般资料

回顾性分析2017年1月-2019年2月于笔者所在医院治疗的150例AOP患儿临床资料，纳入标准：（1）依据《诸福棠实用儿科学》标准诊断[4];（2）患儿呼吸停止时间>20 s，肌张力下降且伴有皮肤青紫症状;（3）入选患儿临床资料完善。排……