Efficacy And Prognostic Factors Of Caffeine Citrate Combined With Heating Humidified High-Frequency Oscillatory Ventilation In The Treatment Of Respiratory Distress Syndrome In Children

Objective To investigate the efficacy and prognostic factors of caffeine citrate combined with heating humidified high-frequency oscillatory ventilation in the treatment of respiratory distress syndrome(RDS)in children.Methods A total of 92 children with RDS admitted to East District of Anhui Maternal and Child Health Hospital from March 2017 to August 2021 were selected as the research objects.According to the random number table method,the research objects were divided into the study group and the control group,with 46 cases in each group.The study group was treated with intravenous caffeine citrate on the basis of the control group.The respiratory conditions,arterial blood pressure partial pressure(Pa O2)before and after treatment were compared between the two groups.Arterial partial pressure of carbon dioxide(Pa CO2),clinical treatment effect,inflammatory factors bone morphogenetic protein-7(BMP-7)and Claracell secreted protein 16(Claracell secreted)were recorded before and after treatment in the two groups protein 16,CC16)and complications.After 6 months of follow-up,46 children in the study group were divided into success group and failure group according to the treatment conditions of caffeine citrate combined with heating humidified high-frequency oscillatory ventilation,including 30 cases in the success group and 16 cases in the failure group.The general conditions of the successful group and the failure group included: Gestational age,birth weight,Apgar5 min score,by vaginal delivery,multiplets,prenatal application hormone,merge artery catheter was not closed(PDA),intrauterine distress,premature rupture of membranes,gestational hypertension,gestational diabetes,intrauterine retarded,arterial blood of subsection(Pa O2),arterial blood pressure(Pa CO2),co2 partial pressure of arterial blood oxygen partial pressure and suction Oxygen concentration ratio(Pa O2/Fi O);Ratio of partial pressure of arterial blood pressure to partial pressure of alveolar oxygen(Pa O2/PAO2),time of first dose of PS,times of PS application,time of oxygen therapy,length of hospital stay,bronchopulmonary dysplasia(BPD),pneumothorax(PNX),retinopathy of prematurity(ROP);And intracranial hemorrhage(ICH),and multivariate logistic regression analysis was performed.Results(1)There were no significant differences in gender,gestational age,birth weight,delivery mode and RDS grade between the study group and the control group(P < 0.05).(2)After treatment,The mechanical ventilation(5.41±1.01)d,oxygen delivery time(6.91±1.25)d and apnea times(4.94±0.92)in the study group were lower than those in the control group(7.01±1.42)d,oxygen delivery time(9.51±1.63)d and apnea times(7.63±1.23).The comparison between the two groups was statistically significant(P <0.05).(3)Before treatment,there was no significant difference in the levels of Pa O2(43.62±7.14)and Pa CO2(59.91±8.03)in the study group and Pa O2(42.73±7.37)and Pa CO2(58.67±8.21)in the control group(P > 0.05).The level of Pa O2(65.83±7.23)after 3 days of treatment and(65.83±7.23)after 5 days of treatment in the study group were higher than those in the control group(50.23±6.01)and(61.23±7.45)after 5 days of treatment.At the same time,the Pa CO2 level of the study group(45.11±7.82)after 3days of treatment and(41.33±6.05)after 5 days of treatment were lower than those of the control group(50.41±8.03)after 3 days of treatment and(44.02±6.93)after 5 days of treatment.The comparison between the two groups was statistically significant(P< 0.05).(4)After treatment,34 cases in the study group were effective,10 cases were effective and 2 cases were ineffective,while 29 cases in the control group were effective,9cases were effective and 8 cases were ineffective.The total clinical effective rates of the two groups were 95.65% and 82.61%,respectively,and the comparison between the groups was statistically significant(P < 0.05).(5)Before treatment,there was no significant difference between the levels of BMP-7(53.91±8.05)and CC16(59.09±9.92)in the study group and the levels of BMP-7(54.72±7.53)and CC16(60.01±10.63)in the control group(P > 0.05).Both groups improved after treatment.The levels of BMP-7(38.02±6.42)and CC16(38.02±6.42)after 3 days of treatment and the levels of BMP-7(35.64±6.03)and CC16(26.91±4.15)after 5 days of treatment in the study group were lower than those in the control group(48.26±7.03)and CC1 after 3 days 6(42.66±7.63),5 days after BMP-7(40.11±6.13),CC16(30.02±4.83)levels,the comparison between groups was statistically significant(P < 0.05).(6)After treatment,the team with a 1 case of bronchial pulmonary dysplasia,1 case of pulmonary infection,1 case of tachycardia,1 case of convulsion and 2 cases of gastrointestinal dysfunction,the control group of children in 1 case of bronchial pulmonary dysplasia,3 cases of pulmonary infection,1 case of tachycardia,1 case of seizures,4 cases of gastrointestinal dysfunction,1 case of abdominal distension,1 case of lung,The total complication rates of the two groups were 13.04% and 26.09%,respectively,and there was no significant difference between the two groups(P <0.05).(7)The results showed that there were no differences in gestational age,Apgar5 min score,multiple births,PDA,intrauterine distress,premature rupture of membranes,gestational hypertension,gestational diabetes mellitus,intrauterine growth retardation,PS first dose time,PS application times,BPD,PNX,ROP and ICH between the successful group and the control group(P > 0.05).There were statistically significant differences in birth weight,transvaginal delivery,prenatal hormone use,Pa O2,Pa CO2,Pa O2/Fi O2,Pa O2/PAO,oxygen therapy time and hospital stay between the successful group and the control group(P < 0.05).(8)logistic regression analysis showed that preoperative use of hormone,transvaginal delivery,oxygen therapy time and hospital stay were the key protective factors for the success of caffeine citrate combined with heating humidified high-frequency oscillatory ventilation in the treatment of children with respiratory distress syndrome.Birth weight < 1150 g,Pa O2 < 65 mm Hg,Pa CO2 > 54 mm Hg,Pa O2/Fi O2 < 195,Pa O2/PAO2 < 0.40 are independent risk factors for failure of caffeine citrate combined with heating humidified high-frequency oscillatory ventilation in the treatment of children with respiratory distress syndrome(P < 0.05).Conclusion The combination of caffeine citrate and heating humidification high-frequency oscillatory ventilation in the treatment of children with RDS has a definite clinical efficacy.It can not only improve the blood gas indicators of the children,control inflammatory reactions,but also reduce the occurrence of complications,making it safe and reliable;Birth weight<1150g,Pa O2<65mm Hg,Pa CO2>54mm Hg,Pa O2/Fi O2<195,Pa O2/PAO2<0.40 are risk factors that affect clinical treatment effectiveness.Preoperative hormone use,vaginal delivery,oxygen therapy time,and hospital stay are protective factors that affect clinical treatment effectiveness.