引用本文:[点击复制]
[点击复制]
【打印本页】 【在线阅读全文】【下载PDF全文】 查看/发表评论下载PDF阅读器关闭

←前一篇|后一篇→

过刊浏览    高级检索

本文已被:浏览 194次   下载 55 本文二维码信息
码上扫一扫!
不同剂量枸橼酸咖啡因在早产儿拔管前对呼吸力学的影响
尚彪,董文斌,何刚,刘娟,白静,田鹏,张鸿,丁小燕
0
(南充市中心医院新生儿科·南充市危重新生儿救治中心;西南医科大学附属医院新生儿科)
摘要:
【摘要】 目的 探讨不同剂量枸橼酸咖啡因在早产儿拔管前对呼吸力学的影响,从而寻找有助于拔管的最佳剂量。方法 将收治的90例机械通气超过48小时且胎龄小于37周的早产儿按随机原则分为枸橼酸咖啡因大剂量组和小剂量组及对照组三组,每组各30例。在积极抗感染、稳定内环境、静脉营养支持及机械通气等基础上,有呼吸窘迫症状和体征的给予肺表面活性物质(pulmonary surfactant,PS)(固尔苏)替代治疗(治疗剂量200mg/kg 气管内给药,必要时可重复给药),大剂量组在准备拔管前24小时或非计划拔管6小时内用枸橼酸咖啡因20mg/kg.d(10min)维持治疗至成功拔管,小持剂量组准备拔管前24小时或非计划拔管6小时内用枸橼酸咖啡因按5mg/kg.d(10min)维持治疗至成功拔管,对照组只给予常规治疗而不给予枸橼酸咖啡因及氨茶碱或其他甲基黄嘌呤药物。记录患儿用药前及拔管前呼吸机参数及使用枸橼酸咖啡因药物前2小时内及拔管后2小时各组的血气分析指标,检测用药治疗前、拔管前及拔管后2小时患者的呼吸力学变化并记录患儿拔管后的通气模式,统计患儿的成功拔管率及不良反应。结果 大剂量组、小剂量组及对照组三组患儿的呼吸力学在拔管前改变为呼吸功(WOB)、气道阻力(Raw)、顺应性(cdyn)比较差异具有统计学意义(P<005);大剂量组与小剂量组、对照组的血气分析指标PaCO2 及PaO2差异均有统计学意义(P<005);拔管成功的整体有效率,差异有统计学意义(P<005);不良反应三组无明显统计学差异(P>005)。结论 大剂量枸橼酸咖啡因对早产儿拔管前呼吸力学的影响积极有效,有助于拔管且成功率明显高于小剂量组及对照组,且不会增加药物的不良反应,可在临床推广运用。
关键词:  早产儿  枸橼酸咖啡因  呼吸力学  拔管
DOI:
基金项目:四川省卫生和计划生育委员会科研课题(16PJ207)
Effects of different doses of caffeine citrate on respiratory mechanics before extubation in premature infants
SHANG Biao,DONG Wenbin,HE Gang,LIU Juan,BAI Jing,TIAN Peng,ZHANG Hong,DING Xiaoyan
(Neonatal Department, Nanchong Central Hospital, Nanchong Critical Neonatal Treatment Center;Department of Pediatrics, The Affiliated Hospital of Southwest Medical University)
Abstract:
【Abstract】 Objective To explore the effects of different doses of caffeine citrate on respiratory mechanics before extubation in preterm infants and to guide extubation. Methods 90 preterm infants with mechanical ventilation more than 48 hours and gestational age less than 37 weeks admitted to our hospital from July 2015 to July 2017 were randomized into caffeine highdose caffeine group, lowdose group and the control group. Under the treatment of the active antiinfective, stable internal environment, intravenous nutrition support and mechanical ventilation, pulmonary surfactant (pulmonary surfactant, PS) replacement therapy (reactive dose 200 mg/kg) with symptoms and signs of respiratory distress intratracheal administration, the highdose group was treated with caffeine 20 mg/kg.d (10 min), until successfully extracted 24 hours before extubation or within 6 hours of unplanned extubation. Tubes, small holding dose groups were treated with caffeine citrate at 5 mg/kg.d (10 min) until extubation within 24 hours before preparation for extubation or within 6 hours of unplanned extubation. The control group received only routine treatment instead of routine treatment. The clinical data were used to record the ventilator parameters before and after extubation and the blood gas analysis indicators of the groups within 2 hours before and after 2 hours of extubation with citrate caffeine, and before, before and after extubation. The patient's respiratory mechanics changes were recorded 2 hours after the procedure and the ventilatory pattern after extubation was recorded. The successful extubation rate and adverse reactions were recorded. Results After different doses of caffeine citrate were used, the respiratory mechanics of the highdose, lowdose and control groups changed to WOB before extubation (801±876) VS (902±903). VS (1217±995) g·cm/(min·Kg), airway resistance (Raw) (6238±1727)VS (6873±1446) VS (7249±1384) cmH2O/(L·s) Compliance (Cdyn) (20±039) vs (158±030) VS (143±037) mL/cmH2O, P<005. The blood gas analysis of each group during the first 2 hours of acid caffeine and 2 hours after extubation was compared. The results showed that the blood gas analysis parameters PaCO2 and PaO2 were high in the highdose group and the lowdose group and the control group (P<005. The overall effective rate of successful extubation of he highdose group, the lowdose group and the control group were 867% , 733% and 567% (P<005). Among the adverse reactions, there was no significant difference between the highdose caffeine caffeine group and the lowdose group and the control group. Conclusion The highdose group (20mg/kg.d) of caffeine citrate had a positive effect on the preextubation respiratory mechanics. It was helpful for extubation and the success rate was significantly higher than that of the lowdose group and the control group. There was no statistically significant difference between the two groups in adverse reactions, so it is worthy of promotion and application in clinical practice.
Key words:  Premature infants  Citrate caffeine  Respiratory mechanics  Extubation

用微信扫一扫

用微信扫一扫