枸橼酸咖啡因对极低出生体重儿潮气呼吸肺功能的影响及动态分析

发布时间：2018-09-03 16:30

【摘要】：早产儿呼吸暂停(apnea of prematurity,AOP)是早产儿尤其是极低出生体重儿呼吸管理中较为常见的疾病[1],并且与早产儿出生体重和胎龄有着非常密切的关系,胎龄、体重越小,AOP发生的可能性越大,体重小于1000g的早产儿即超低出生体重儿呼吸暂停发生率高达80%左右[2]。胎龄在三十周至三十二周的早产儿呼吸暂停发生率为50%左右。呼吸暂停可引起心动过缓、低氧血症,增加脑积水、脑室内出血及神经系统发育异常的风险[3],严重时可能出现死亡。目前国际上治疗AOP的主要药物是甲基黄嘌呤类药物,枸橼酸咖啡因和氨茶碱均属于黄嘌呤类药物。有研究表明枸橼酸咖啡因可以减少低氧血症时间及机械通气时间、降低支气管肺发育不良(Brochopulmonary dysplasia,BPD)的发生率。但目前对有呼吸暂停的患儿肺发育情况研究不多。早产儿肺功能检测是判断呼吸系统发育程度[4]、探究呼吸系统疾病及寻找其生长发育规律的十分重要方法[5]。在临床上可以根据肺功能检测结果判断呼吸系统疾病的性质、严重程度及监控疾病发展过程,也可以在治疗的过程中评估治疗效果、协助选择呼吸机的参数、指导并判断预后。常规的肺功能检查通常要求受试者非常积极的配合,这大大的阻碍了常规肺功能检测在儿童和新生儿中的应用。潮气呼吸肺功能的检测只是需要平静呼吸,操作相对简单,更加适合不能配合的患者,比如说新生儿及年龄小的儿童,所以在临床上获得了越来越多的重视和应用。本文通过枸橼酸咖啡因对有AOP的极低出生体重儿治疗后不同时期潮气呼吸肺功能的分析及动态随访,以进一步探讨枸橼酸咖啡因对其肺部发育所造成的影响。目的通过对住院期间有AOP的极低出生体重儿进行潮气呼吸肺功能检测及重要肺功能参数的比较,以探讨枸橼酸咖啡因对极低出生体重儿肺功能的影响。方法1.研究对象分组本次试验研究对象为在2015年12月至2016年12月期间在郑州大学第三附属医院新生儿病房住院的120例有原发性呼吸暂停的极低出生体重儿(出生体重1000g~1499g),随机根据数字法分为氨茶碱应用组(P1)和枸橼酸咖啡因应用组(P2),每组各60例。排除标准:(1)围生期有重度窒息史、神经系统疾病或功能紊乱;(2)一级亲属中有哮喘史;(3)母亲有吸烟史;(4)存在严重的呼吸窘迫综合征等呼吸系统疾病;(5)颅内出血;(6)败血症等感染性疾病;(7)消化系统疾病及电解质紊乱;(8)严重的先天性心脏疾病(9)遗传代谢性疾病;(10)药物应用疗程不足者、评估之前死亡者、放弃治疗者;(11)其他因素所引发的继发性呼吸暂停[4]。2.方法本次试验研究选用潮气呼吸法,在患儿自然睡眠或药物睡眠(药物选用10%水合氯醛0.3~0.5m1/kg口服或灌肠)、平静呼吸状态下,将受试者口鼻用面罩扣紧,经流速传感器将流速信号积分成容量,测得值可经电脑自动生成并做好记录。测时前还需要常规记录患儿的性别、胎龄,并测量患儿的身长和体质量,测定的主要参数有:潮气量(Tidal volume,TV)、吸气时间(Inspiratory time,TI)、呼气时间(Expiratory time,TE)、呼吸频率(Respiratory rate,RR)、达峰时间比(Ratio of TPEF and total tE,TPEF/TE)、达峰容积比(Ratio of VPEF and totalVE,VPEF/VE)。本试验已经获得我院人体试验委员会批准及患儿监护人书面知情同意书。对研究对象进行第一次潮气呼吸肺功能检测在患儿停用枸橼酸咖啡因或氨茶碱后(最迟不超过生后34周)进行;并对两组患儿随访,分别在校正胎龄40周时和出生后3个月对两组患儿进行潮气呼吸肺功能的检测,并采用统计学方法进行分析,研究枸橼酸咖啡因对极低出生体重儿在不同时期潮气呼吸肺功能的影响。结果1.两组一般资料比较两组极低出生体重儿胎龄、出生体重、5minApgar评分均无统计学差异(P0.05)。2.停药后(最迟不超过生后34周)测定两组潮气呼吸肺功能主要参数的差异试验组即咖啡因组潮气量、达峰容积比、达峰时间比、25%潮气量时呼气流速均高于对照组即氨茶碱组,并且与氨茶碱组相比有统计学意义(p0.05),余各项潮气呼吸肺功能指标无明显统计学差异(p0.05)。3.极低出生体重儿在校正胎龄40周时两组潮气呼吸肺功能主要参数的差异在极低出生体重儿在校正胎龄40周时试验组即咖啡因组潮气量、达峰时间比及50%潮气量时呼气流速、25%潮气量时呼气流速均高于对照组即氨茶碱组,其差异有统计学意义(p0.05),余各项潮气呼吸肺功能指标无明显统计学差异(p0.05)。4.出生后3个月两组肺功潮气呼吸肺功能主要参数的差异极低出生体重儿出生后3个月时试验组即咖啡因组潮气量较对照组即氨茶碱组高,并且差异有统计学意义(p0.05);而达峰容积比、达峰时间比及75%潮气量时呼气流速、50%潮气量时呼气流速、25%潮气量时呼气流速与氨茶碱组相比无统计学意义(p0.05)。结论枸橼酸咖啡因治疗极低出生体重儿呼吸暂停近远期潮气呼吸肺功能均有明显改善。
[Abstract]:Premature apnea of prematurity (AOP) is a common disease in respiratory management of premature infants, especially very low birth weight infants [1], and has a very close relationship with the birth weight and gestational age of premature infants. The smaller the gestational age and weight, the greater the possibility of AOP. Premature infants weighing less than 1000g are called very low birth weight infants. The incidence of apnea is as high as 80%[2]. The incidence of apnea is about 50% in preterm infants between 30 and 32 weeks of gestation. Apnea can cause bradycardia, hypoxemia, increase the risk of hydrocephalus, intraventricular hemorrhage and abnormal nervous system development [3], and may lead to death in severe cases. Caffeine citrate and aminophylline are xanthine drugs. Studies have shown that caffeine citrate can reduce the duration of hypoxemia and mechanical ventilation, and reduce the incidence of bronchopulmonary dysplasia (BPD). Premature infants'pulmonary function test is a very important method to judge the degree of respiratory system development, explore the respiratory system diseases and find out their growth and development rules [5].In clinic, according to the results of pulmonary function test, we can judge the nature of respiratory system diseases, severity and monitor the process of disease development, and can also be treated too. Routine pulmonary function tests usually require very active cooperation, which greatly hinders the application of routine pulmonary function tests in children and newborns. More and more attention has been paid to the use of caffeine citrate in the treatment of very low birth weight (VLBW) infants with AOP. In this paper, we analyzed the tidal respiratory and pulmonary function of infants with AOP at different stages after treatment and followed up dynamically. Objective To investigate the effects of caffeine citrate on pulmonary function in very low birth weight infants with AOP during hospitalization by tidal breathing pulmonary function test and comparison of important pulmonary function parameters. Methods 1. Subjects were divided into two groups: subjects from December 2015 to December 2015. 120 very low birth weight infants with primary apnea (birth weight 1000g ~ 1499g) hospitalized in the neonatal ward of the Third Affiliated Hospital of Zhengzhou University in December 2016 were randomly divided into aminophylline application group (P1) and caffeine citrate application group (P2), 60 in each group. Exclusive criteria: (1) severe asphyxia occurred during perinatal period. Nervous system disease or dysfunction; (2) First degree relatives have a history of asthma; (3) mothers have a history of smoking; (4) severe respiratory distress syndrome and other respiratory diseases; (5) intracranial hemorrhage; (6) septicemia and other infectious diseases; (7) digestive system disease and electrolyte disorders; (8) serious congenital heart disease; (9) genetic metabolic diseases; (10) Methods In this study, tidal breathing was used to treat the children with spontaneous sleep or drug sleep (10% chloral hydrate 0.3-0.5m1/kg orally or enema) and the subjects were given oral sedation breathing. The nasal mask is fastened tightly, and the flow signal is integrated into volume by flow sensor. The measured value can be automatically generated and recorded by computer. Expiratory time (TE), Respiratory rate (RR), Ratio of TPEF and total time (TPEF/TE), Ratio of VPEF and total volume (VPEF/VE). This experiment has been approved by the Human Trial Committee of our hospital and written informed consent of the patient's guardian. Pulmonary function test was performed after cessation of caffeine citrate or aminophylline (no later than 34 weeks after birth); and two groups of children were followed up, respectively at the adjusted gestational age of 40 weeks and 3 months after birth, tidal breathing pulmonary function of the two groups of children were tested, and statistical methods were used to analyze the effect of caffeine citrate on very low levels. Results 1. There was no significant difference in gestational age, birth weight and 5-minute Apgar score between the two groups (P 0.05). 2. After stopping medication (no later than 34 weeks after birth) to determine the main parameters of tidal breathing lung function between the two groups: caffeine group Tidal volume, peak volume ratio, peak time ratio, expiratory flow rate at 25% tidal volume were higher than those in the control group, that is, aminophylline group, and there was statistical significance compared with aminophylline group (p0.05). There was no significant difference in the remaining tidal respiratory lung function indicators between the two groups (p0.05). 3. The difference of main parameters was that the tidal volume, peak time ratio, expiratory velocity at 50% tidal volume, and expiratory velocity at 25% tidal volume of very low birth weight infants were higher than those of the control group (aminophylline group) at 40 weeks of corrected gestational age (p0.05). 3 months after birth, the main parameters of pulmonary function were different between the two groups. 3 months after birth, the tidal volume of caffeine group was higher than that of aminophylline group, and the difference was statistically significant (p0.05); and the peak volume ratio, peak time ratio and 75% tidal volume, expiratory velocity, 50% tidal volume Respiratory flow at expiratory volume and at 25% tidal volume were not significantly different from those in aminophylline group (p0.05). Conclusion Caffeine citrate can significantly improve the lung function in very low birth weight infants with apnea.
【学位授予单位】：郑州大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R722.6

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