The Effect Of Different Maintenance Doses Of Caffeine Citrate On Respiratory Mechanics And Extubation In Preterm Infants During The Peri-extubation Period

Objective To investigate the effects of different maintenance doses of citrate caffeine on respiratory mechanics and extubation during peri-extubation in preterm infants with gestational age?GA?<35 weeks and mechanical ventilation>48 hours.Methods From July 2015 to July 2017 in our hospital,90 cases of mechanical ventilation over 48 hours and gestational age less than 35 weeks of premature infant were randomly divided into high-maintenance dose of citrulline citrate and low-maintenance dose group,control groupeach group of 30 cases.On the basis of positive anti-infection,stable internal environment,intravenous nutritional support and mechanical ventilation,patients with respiratory distress symptoms and signs were given surrogate of pulmonary surfactant?PS??Cure?instead of 200 mg/kg Intratracheal administration,if necessary,repeated administration),high maintenance dose group is expected to be extubated 36 hours before excretion with citrate caffeine20mg/kg?30min?saturation and 24 hours after 10mg/kg.d?10min?Maintenance treatment to 3 days after successful extubation,low maintenance dose group is expected to be prepared 36 hours before extubation saturated with citrate caffeine20mg/kg?30min?and 24 hours after 5mg/kg.d?10min?Maintenance treatment to 3days after successful extubation,the control group was given only routine treatment without giving citrate caffeine and aminophylline or other methylxanthine medications.Successful extubation were given oxygen inhalation or nCPAP supportive treatment,etc.nCPAP premature infant were recorded for comparison of ventilatory time;extubation failure was again given intubation mechanical ventilation.The clinical data were recorded in the use of caffeine citrate treatment before extubation and blood gas analysis indicators 2 hours each tube within 2 hours and before pulling machine parameters and the use of caffeine citrate drugs before and after the changes of respiratory mechanics in premature infants before the tube before and after extubation and the changes of blood gas analysis PaCO₂ and PaO₂ value and record each ventilation mode after extubation Stubbs were compared before treatment,and the incidence of adverse reactions,pulled out successfully statistics with the tube.Results It was found that the respiratory mechanics of the high maintenance dose group,low maintenance dose group and control group was changed into respiratory function?WOB?comparison?801±87.6?VS?902±90.3?VS?1217±99.5?g·cm/?min·Kg?,Airway resistance?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,significant difference,statistically significant?<P 0.05?;At the same time,we compared the blood gas analysis of 2 hours before and 2 hours after the extraction of the caffeine citrate drug,and the blood gas analysis index of PaCO2 and PaO2 in the high maintenance dose group and the low maintenance dose group and the control group?P<0.05?.The overall effective high maintenance dose group was 86.7%,while the low maintenance dose group and control group were 73.3%and 56.7%respectively.On the side effect of methylxanthine,there was no significant difference between high-maintenance dose group and low-maintenance dose group and control group?P>0.05?.Conclusion High maintenance dose group?10 mg/kg.d?citrate caffeine has positive and effective effects on respiratory mechanics during extubation of premature infants,which could help to improve the success rate of extubation obviously,so it was worth popularizing and applying in clinic.