咖啡因联合经鼻高流量氧疗治疗新生儿呼吸窘迫综合征的疗效观察

Therapeutic efficacy of caffeine combined with high-flow nasal cannula oxygen therapy for neonatal respiratory distress syndrome

摘要:

目的 分析咖啡因联合经鼻高流量氧疗治疗新生儿呼吸窘迫综合征（NRDS）的疗效。方法 前瞻性选取2020年3月—2023年6月亳州市人民医院收治的98例NRDS患儿，按随机数字表法分为对照组和研究组，每组49例。对照组给予经鼻高流量氧疗，研究组在对照组基础上另给予枸橼酸咖啡因治疗，治疗后7 d观察效果。对比两组无创通气时间、总用氧时间、呼吸暂停次数、血气指标、呼吸力学指标、临床疗效、炎症因子及并发症情况。结果 研究组无创通气时间、总用氧时间、呼吸暂停次数均低于对照组（P <0.05）。研究组与对照组治疗前、治疗后3和7 d的二氧化碳分压（PaCO₂）、血氧分压（PaO₂）比较，结果 ①不同时间点PaO₂、PaCO₂比较，差异均有统计学意义（F =7.961和8.038，均P =0.000）；②研究组与对照组PaO₂、PaCO₂比较，差异均有统计学意义（F =7.958和6.987，均P =0.000）；③两组PaO₂、PaCO₂变化趋势比较，差异均有统计学意义（F =8.057和8.136，均P =0.000）。研究组与对照组治疗前、治疗后3和7 d的气道阻力、内源性呼气末正压比较，结果 ①不同时间点气道阻力、内源性呼气末正压比较，差异均有统计学意义（F =7.854和8.126，均P= 0.000）；②研究组与对照组气道阻力、内源性呼气末正压比较，差异均有统计学意义（F =8.236和7.958，均P =0.000）；③两组气道阻力、内源性呼气末正压变化趋势比较，差异均有统计学意义（F =7.968和8.027，均P =0.000）。研究组总有效率高于对照组（P <0.05）。研究组治疗前后骨形态发生蛋白-7、Clara细胞分泌蛋白16、肿瘤坏死因子-α、C反应蛋白的差值均高于对照组（P <0.05）。两组总并发症发生率比较，差异无统计学意义（P >0.05）。结论 咖啡因联合经鼻高流量氧疗治疗NRDS疗效显著，可改善患儿血气及呼吸力学指标，抑制炎症反应，安全可靠。

Abstract:

Objective To analyze the therapeutic efficacy of caffeine combined with high-flow nasal cannula oxygen therapy for neonatal respiratory distress syndrome (NRDS).Methods Ninety-eight children with NRDS admitted to our hospital from March 2020 to June 2023 were prospectively selected, and were divided into the control group and the study group by the random number table method, with 49 cases in each group. The control group was given high-flow nasal cannula oxygen therapy, and the study group was additionally given caffeine citrate therapy. The effects were observed after 7 days of treatment. The duration of noninvasive ventilation, overall duration of oxygen therapy, frequency of apnea, blood gas indicators, respiratory mechanics measurements, clinical efficacy, inflammatory factors and complications were compared between the two groups.Results The duration of noninvasive ventilation and the overall duration of oxygen therapy were shorter, and the frequency of apnea was lower in the study group than in the control group (P < 0.05). The comparison of partial pressure of carbon dioxide (PaCO₂) and partial pressure of oxygen (PaO₂) in the two groups before and 3 d and 7 d after treatment showed that they were different among the time points (F = 7.961 and 8.038, both P = 0.000) and between the two groups (F = 7.958 and 6.987, both P = 0.000), and that the change trends of them were different between the two groups (F = 8.057 and 8.136, both P = 0.000). The comparison of airway resistance and intrinsic positive end-expiratory pressure in the two groups before and 3 d and 7 d after treatment revealed that they were different among the time points (F = 7.854 and 8.126, both P = 0.000) and between the two groups (F = 8.236 and 7.958, both P = 0.000), and that the change trends of them were also different between the two groups (F = 7.968 and 8.027, both P = 0.000). The overall effective rate of the study group was higher than that of the control group (P < 0.05). The differences of the levels of bone morphogenetic protein-7, Clara cell secretory protein 16, tumor necrosis factor-α and C-reactive protein before and after treatment in the study group were higher than those in the control group (P < 0.05). There was no significant difference in the overall incidence of complications between the two groups (P > 0.05).Conclusion Caffeine combined with high-flow nasal cannula oxygen therapy is effective in treating NRDS by improving blood gas indicators and respiratory mechanics measurements and inhibiting the inflammatory response, and is considered safe and reliable.