Clinical Application Of Citrate Caffeine Combined With Nasal Intermittent Positive Pressure Ventilation In Extubation In Very Low Birth Weight Infants

Objective:Neonatal respiratory distress syndrome(NRDS)is one of the most common critical illnesses in neonates,and it is also one of the important causes of neonatal death.It is more common in premature infants,and the smaller the gestational age,the lower the weight.The higher the incidence rate.With the development of perinatal medicine in China,the birth rate of premature infants is increasing year by year,and the success rate of low birth weight infants and very low birth weight infants is getting higher and higher.Therefore,this study explored the clinical application of Nasal intermittent positive pressure ventilation(NIPPV)in the extraction of very low birth weight infants to guide clinical treatment and prevention..Methods:The neonates who were admitted to the our hospital from January 2017 to December 2018,who met the diagnostic criteria for very low birth weight infants,and those who required tracheal intubation and assisted respiration after admission,were randomly divided into experimental groups according to the order of admission.And the control group,30 cases in each group,the experimental group was given NIPPV mode assisted breathing after removal of the tracheal intubation,and intravenous injection of citrate caffeine injection(specification 1ml:20mg),the initial dose was 20mg/kg,After 24 hours,the maintenance dose was 5mg/kg.d until the clinical symptoms of the child,the respiratory state was stable,the heart rate and blood pressure were monitored in the normal range,and the blood gas analysis results were in the normal range,and the application was stopped.In the control group,only NIPPV-assisted respiration was given after the tracheal intubation was removed,and the clinical symptoms were significantly improved after the application.The two groups recorded the general condition of very low birth weight infants,including gestational age,gender,birth weight,1-minute Apgar score,and RDS indexing.The arterial blood gas results of the children before extubation,2 h and 12 h after extubation were recorded.The incidence of complications associated with Intraventricular hemorrhage(IVH),Bronchopulmonary dysplasia(BPD),and Necrotizing enterocolitis(NEC);recording ventilator use time,length of hospital stay,reintubation rate.Results:The two groups of very low birth weight infants were premature infants.The general situation of the two groups was compared.The difference between the two groups was not statistically significant(P>0.05).The PH was found by analyzing the blood gas before extubation.The difference between PaO2 and PaCO2 was not statistically significant(P>0.05),but the blood gas analysis results 2 hours after extubation.The PH of the experimental group was better than the control group(control group 7.35±0.03,experimental group 7.37±0.04)The difference was statistically significant(t=2.087,P<0.05),PaO2 was higher than the control group(control group 60.03±2.99mmHg,experimental group 62.37±5.47mmHg),the difference was statistically significant(t=2.051,P<0.05).PaCO2 was lower than the control group(42.97±2.11mmHg in the control group and 41.40±1.96mmHg in the experimental group),and the difference was also statistically significant(t=2.982,P<0.05).The blood gas analysis result was better than NIPPV in the caffeine combined with NIPPV group after extubation.The blood gas analysis results of 12h after extubation showed that the PH value of the two groups was improved compared with the 2h after extubation(the control group was 7.34±0.06,the experimental group was 7.36±0.04),and the difference was statistically significant(t=2.324,P<0.05),the PaO2 experimental group was superior to the control group(control group 61.43±3.95mmHg,The experimental group was 64.23±5.54mmHg),the difference was statistically significant(t=2.252,P<0.05);the PaCO2 was slightly lower in the two groups,but the experimental group was also superior to the control group(40.73±1.91mmHg in the control group and 39.27±1.98mmHg in the experimental group).The difference was statistically significant(t=2.918,P<0.05).There was no significant difference in the incidence of necrotizing enterocolitis between the two groups(X~2=0.185,P>0.05);the incidence of bronchopulmonary dysplasia in the experimental group was6.7%,and that in the control group was 26.7%.Statistical significance(X~2=4.320,P<0.05),intraventricular hemorrhage rate was 10.0%in the experimental group,compared with 33.3%in the control group,the difference was statistically significant(X~2=4.812,P<0.05).The ventilator use time of the two groups(control group 7.10±2.44,d experimental group5.77±2.08d,t=2.278,P<0.05),hospitalization time required(33.50±7.18d,28.77±6.88d,t=2.606,P<0.05),The intubation rate(26.7%,6.7%)was lower in the above experimental group than in the control group,and the difference was statistically significant(X~2=4.320,P<0.05).Conclusion:Caffeine citrate combined with nasal intermittent positive pressure ventilation can improve the respiratory state of very low birth weight infants after extubation,,reducing high carbonation The occurrence of blood.The citrate caffeine group can reduce the occurrence of complications such as bronchopulmonary dysplasia and intraventricular hemorrhage.The citrate caffeine group had a certain advantage in ventilator use time,hospital stay,and reintubation rate compared with the nasal intermittent positive pressure ventilation group alone.