微创肺表面活性物质给药联合枸橼酸咖啡因注射液对新生儿呼吸窘迫综合征的疗效观察

Efficacy of minimally invasive pulmonary surfactant administration combined with caffeine citrate injection in neonates with NRDS

摘要:

目的 观察微创肺表面活性物质给药联合枸橼酸咖啡因注射液治疗新生儿呼吸窘迫综合征（NRDS）的临床疗效及安全性，分析其对患儿呼吸功能、炎症水平及预后的影响。方法 前瞻性选取2024年3月—2026年3月邯郸市第一医院收治的114例NRDS患儿为研究对象，采用随机数字表法分为A、B、C 3组，各38例。所有患儿接受NRDS常规对症治疗。A组单用微创肺表面活性物质给药治疗，B组单用枸橼酸咖啡因注射液治疗，C组采用微创肺表面活性物质给药联合枸橼酸咖啡因注射液治疗。比较3组患儿的临床疗效、临床相关指标，治疗前后的血气指标、炎症因子水平，并统计3组患儿支气管肺发育不良、脑室周围-脑室内出血、早产儿视网膜病变、新生儿坏死性小肠结肠炎、呼吸机相关性肺炎等并发症发生情况。结果 3组患儿临床总有效率比较，差异有统计学意义（P <0.05）。C组呼吸暂停次数和住院时间均少于A组、B组（P <0.05），且A组少于B组（P <0.05）；C组呼吸机使用时间短于A组、B组（P <0.05）；B组氧气使用时间长于A组、C组（P <0.05）。3组撤机失败率比较，差异无统计学意义（P >0.05）。治疗后，C组pH值、动脉血氧分压（PaO₂）均高于A组、B组（P <0.05），动脉血二氧化碳分压（PaCO₂）低于A组、B组（P <0.05）；3组pH值、PaO₂均较治疗前升高（P <0.05），PaCO₂均较治疗前降低（P <0.05）。C组C反应蛋白、降钙素原及白细胞介素-6水平均低于A组、B组（P <0.05），且A组低于B组（P <0.05）；3组上述指标均较治疗前降低（P <0.05）。3组并发症总发生率比较，差异无统计学意义（P >0.05）。结论 微创肺表面活性物质联合枸橼酸咖啡因可提高NRDS的临床疗效，减少呼吸暂停发作，缩短通气、氧疗及住院时间，并改善血气和炎症指标，在改善呼吸功能及炎症指标方面优于单药治疗。

Abstract:

Objective To evaluate the clinical efficacy and safety of minimally invasive pulmonary surfactant administration combined with caffeine citrate injection in neonates with neonatal respiratory distress syndrome (NRDS) and to analyze its effects on respiratory function, inflammation, and prognosis.Methods A total of 114 neonates with NRDS admitted to Handan No. 1 Hospital from March 2024 to March 2026 were prospectively enrolled. Using a random number table, they were divided into groups A, B, and C, with 38 neonates in each group. All neonates received conventional symptomatic treatment for NRDS. Group A received minimally invasive pulmonary surfactant administration alone, group B received caffeine citrate injection alone, and group C received the combination of both treatments. Clinical efficacy and clinical indicators, blood gas indices and inflammatory factor levels before and after treatment, and the incidences of bronchopulmonary dysplasia, periventricular-intraventricular hemorrhage, retinopathy of prematurity, neonatal necrotizing enterocolitis, and ventilator-associated pneumonia were compared among the three groups.Results Significant differences were observed in overall response rates among the three groups (P < 0.05). The number of apnea episodes and length of hospital stay were lower in group C than in groups A and B and were lower in group A than in group B (P < 0.05). The duration of mechanical ventilation was shorter in group C than in groups A and B (P < 0.05), whereas the duration of oxygen therapy was longer in group B than in groups A and C (P < 0.05). The rate of weaning failure did not differ significantly among the three groups (P > 0.05). After treatment, pH and arterial partial pressure of oxygen (PaO₂) were higher and arterial partial pressure of carbon dioxide (PaCO₂) was lower in group C than in groups A and B (P < 0.05). In all three groups, pH and PaO₂ increased and PaCO₂ decreased after treatment (P < 0.05). C-reactive protein (CRP), procalcitonin (PCT), and interleukin-6 (IL-6) levels were lower in group C than in groups A and B and were lower in group A than in group B (P < 0.05). These indices decreased after treatment in all three groups (P < 0.05). The total incidence of complications did not differ significantly among the three groups (P > 0.05).Conclusion Minimally invasive pulmonary surfactant administration combined with caffeine citrate improves the clinical efficacy of treatment for NRDS, reduces apnea episodes, shortens the durations of ventilation, oxygen therapy, and hospitalization, and improves blood gas and inflammatory indices. It is superior to either treatment alone in improving respiratory function and inflammatory indices.