摘要
目的:探究枸橼酸咖啡因联合肺表面活性物质治疗早产儿呼吸暂停的效果。方法:选取2021年3月—2023年3月上饶市立医院新生儿科收治的呼吸暂停早产儿94例,按照随机数字表法将其分为对照组(枸橼酸咖啡因治疗)及观察组(枸橼酸咖啡因联合肺表面活性物质治疗),各47例。比较两组临床指标(呼吸暂停发作次数、机械通气时间、吸氧时间)、血气指标[pH、血氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))]、肺功能指标[潮气量(TV)、每分钟通气量(MV)、达峰时间比、达峰容积比]、相关细胞因子水平[血清铁蛋白(SF)、Clara细胞分泌蛋白16(CC16)、骨形态发生蛋白-7(BMP-7)、β-内啡肽(β-EP)]、氧化应激水平[超氧化物歧化酶(SOD)、丙二醛(MDA)、谷胱甘肽(GSH)、一氧化氮(NO)]。结果:观察组呼吸暂停发作次数少于对照组,观察组机械通气时间、吸氧时间均短于对照组,差异均有统计学意义(P<0.05)。治疗前,两组pH、PaO_(2)、PaCO_(2)、SaO_(2)水平比较,差异均无统计学意义(P>0.05);治疗后,两组pH、PaO_(2)、SaO_(2)水平较治疗前均升高,且观察组pH、PaO_(2)、SaO_(2)均高于对照组,两组PaCO_(2)水平较治疗前均降低,且观察组PaCO_(2)低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组TV、MV、达峰时间比、达峰容积比比较,差异均无统计学意义(P>0.05);治疗后,两组TV、MV较治疗前均降低,且观察组均低于对照组;达峰时间比、达峰容积比较治疗前均升高,且观察组均高于对照组,差异均有统计学意义(P<0.05)。治疗前,两组SF、CC16、BMP-7、β-EP对比,差异均无统计学意义(P>0.05);治疗后,两组SF、CC16、BMP-7、β-EP较治疗前均降低,且观察组SF、CC16、BMP-7、β-EP均低于对照组,差异均有统计学意义(P<0.05)。治疗前,两组SOD、MDA、GSH、NO比较,差异均无统计学意义(P>0.05);治疗后,两组MDA、NO较治疗前均降低、SOD、GSH较治疗前均升高,且观察组MDA、NO均低于对照组,SOD、GSH均高于对照组,差异均有统计学意义(P<0.05)。结论:呼吸暂停早产儿采用枸橼酸咖啡因联合肺表面活性物质治疗,可改善患儿血气指标,提升肺功能,降低SF及CC16、BMP-7水平,提升抗氧化能力,促进神经功能发育。
Objective:To investigate the effect of Caffeine Citrate combined with lung surface active substance in the treatment of apnea in preterm infants.Method:A total of 94 cases of preterm infants with apnea admitted to the Neonatology Department of Shangrao Municipal Hospital from March 2021 to March 2023 were selected and divided into the control group(treated with Caffeine Citrate)and the observation group(treated with Caffeine Citrate combined with lung surface active substances)according to the random number table method,with 47 cases each group.The two groups were compared in terms of clinical indicators(number of apnea episodes,duration of mechanical ventilation,duration of oxygen intake),blood gas indicators[pH,partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),and oxygen saturation(SaO_(2))],pulmonary function indicators[tidal volume(TV),ventilation per minute(MV),ratio of time to peak tidal expiratory flow to total expiratory time,ratio of volume at peak tidal expiratory flow to expiratory tidal volume]and the levels of relevant cytokines[serum ferritin(SF),Clara cell secretory protein 16(CC16),bone morphogenetic protein-7(BMP-7),β-endorphin(β-EP)],and oxidative stress levels [superoxide dismutase (SOD), malondialdehyde (MDA), glutathione (GSH), nitric oxide (NO)]. Result: The number of apnoea episodes in the observation group was less than that in the control group, and the duration of mechanical ventilation and oxygenation in the observation group were shorter than those in the control group, the differences were statistically significant (P<0.05). Before treatment, the levels of pH, PaO_(2), PaCO_(2) and SaO_(2) of the two groups were compared, the differences were not statistically significant (P>0.05);after treatment, the levels of pH, PaO_(2) and SaO_(2) in both groups were higher than those before treatment, and the pH, PaO_(2) and SaO_(2) in observation group were higher than those in control group, PaCO_(2) levels in both groups were lower than those before treatment, and PaCO_(2) in the observation group was lower than that in the control group, the differences were statistically significant (P<0.05). Before treatment, there were no significant differences in TV, MV, ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume at peak tidal expiratory flow to expiratory tidal volume between the two groups (P>0.05);after treatment, TV and MV in both groups were lower than those before treatment, and those in the observation group were lower than those in the control group, ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume at peak tidal expiratory flow to expiratory tidal volume were higher than those before treatment, and those in the observation group were higher than those in the control group, the differences were statistically significant (P<0.05). Before treatment, SF, CC16, BMP-7 and β-EP were compared between the two groups, the differences were not statistically significant (P>0.05);after treatment, SF, CC16, BMP-7 and β-EP were reduced in both groups compared with those before treatment, and SF, CC16, BMP-7 and β-EP were lower in the observation group than those in the control group, and the differences were statistically significant (P<0.05). Before treatment, SOD, MDA, GSH and NO of the two groups were compared, the differences were not statistically significant (P>0.05);after treatment, MDA and NO of the two groups were reduced and SOD and GSH were increased compared with those before treatment, and MDA and NO in the observation group were lower than those in the control group, and SOD and GSH were higher than those in the control group, the differences were statistically significant (P<0.05). Conclusion: The treatment of apneic preterm infants with Caffeine Citrate combined with lung surface active substances can improve the children's blood gas indexes, enhance the lung function, reduce the levels of SF and CC16, BMP-7, enhance the antioxidant capacity, and promote the development of neurological function.
作者
徐斐
肖静
XU Fei;XIAO Jing(Shangrao Municipal Hospital,Jiangxi Province,Shangrao 334000,China;不详)
出处
《中国医学创新》
CAS
2023年第27期48-53,共6页
Medical Innovation of China
关键词
枸橼酸咖啡因
肺表面活性物质
早产儿呼吸暂停
肺功能
血气指标
Caffeine Citrate
Lung surface active substances
Apnea of prematurity
Pulmonary function
Blood gas indexes
