早期咖啡因治疗对呼吸窘迫综合征早产儿呼吸机需求的影响研究

Effect of early caffeine treatment on the need for respirator therapy in preterm infants with respiratory distress syndrome

摘要:

目的 研究早期静脉注射咖啡因对呼吸窘迫综合征（RDS）早产儿的影响。方法 通过前瞻性临床对照研究，选择进行机械通气的RDS早产儿59例，分成咖啡因组（n=30）和对照组（n=29）。咖啡因组在生后12~24 h开始使用咖啡因，对照组在计划拔除气管插管前4~6 h开始给予咖啡因（剂量同咖啡因组）。比较两组呼吸机参数，以及呼吸机相关性肺炎（VAP）、呼吸暂停（AOP）等并发症发生情况。结果 咖啡因组最高吸气峰压（PIP）、最高吸入氧浓度（FiO₂）及VAP发生率明显低于对照组（P < 0.05）。咖啡因组插管时间、NCPAP时间、总需氧时间均明显短于对照组（P < 0.05），拔管后首次AOP发生时间明显迟于对照组（P < 0.05），拔管后1~2 d AOP的发生次数也明显少于对照组（P < 0.01）。结论 早期应用咖啡因治疗能减少RDS早产儿对辅助通气的需求，有助于早期拔管及撤离呼吸机，减少VAP及拔管后AOP的发生。

Abstract:

Objective To study the efficacy of early caffeine treatment in preterm infants with respiratory distress syndrome (RDS). Methods A prospective controlled clinical trial was performed. A total of 59 preterm infants with RDS were enrolled and divided into a caffeine group (30 infants) and a control group (29 infants). Caffeine was administered in the caffeine group and control group at the same dosage at 12-24 hours after birth and before extubation respectively. The respirator parameters and the incidence rates of ventilator-associated pneumonia (VAP) and apnea were compared between the two groups. Results Compared with the control group, the caffeine group had significantly lower peak inspiratory pressure, peak fraction of inspired oxygen, and incidence rate of VAP (P < 0.05), as well as significantly shorter intubation time, NCPAP time, and total duration of oxygen supply (P < 0.05). In addition, the caffeine group had a significantly longer time to first onset of apnea after extubation (P < 0.05) and significantly fewer times of onset of apnea 1-2 days after extubation (P < 0.01), as compared with the control group. Conclusions Early caffeine treatment can reduce the need for assisted ventilation in preterm infants with RDS, help with early extubation and ventilator weaning, reduce the oxygen time in the late stage, reduce the incidence of VAP, and prevent the development of apnea after extubation.