枸橼酸咖啡因注射液联合双水平正压通气治疗新生儿呼吸窘迫综合征的效果观察

沈建超 尹大猛

【摘要】 目的：探討枸橼酸咖啡因注射液联合双水平正压通气（BiPAP）治疗新生儿呼吸窘迫综合征（NRDS）的效果。方法：选取2018年6月—2023年6月连云港市第二人民医院收治的100例NRDS患儿为研究对象，按1∶1比例随机分为研究组和对照组。对照组50例患儿接受BiPAP治疗，研究组50例患儿在此基础上联合应用枸橼酸咖啡因注射液。比较两组临床指标、肺损伤指标[肺表面活性蛋白A（SP-A）、Toll样受体2（TLR-2）和Toll样受体4（TLR-4）]、血气指标[动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、和吸入氧浓度（FiO2）]及治疗期间呼吸衰竭、败血症、肺出血和气胸等并发症发生情况。结果：治疗后，研究组临床指标、肺损伤指标、血气指标均显著优于对照组（P<0.05）。研究组呼吸衰竭、败血症、肺出血和气胸等并发症发生率显著低于对照组（P<0.05）。结论：枸橼酸咖啡因注射液联合BiPAP能显著改善NRDS患儿的临床指标、肺损伤和血气情况，降低并发症发生率，具有明显的治疗效果。

【关键词】 枸橼酸咖啡因注射液 双水平正压通气 新生儿呼吸窘迫综合征 临床指标 肺损伤 血气分析 并发症

Observation on the Effect of Caffeine Citrate Injection Combined with Bilevel Positive Airway Pressure in the Treatment of Neonatal Respiratory Distress Syndrome/SHEN Jianchao， YIN Dameng. //Medical Innovation of China， 2024， 21（08）： 0-051

[Abstract] Objective： To investigate the effect of Caffeine Citrate Injection combined with bilevel positive airway pressure （BiPAP） in the treatment of neonatal respiratory distress syndrome （NRDS）. Method： A total of 100 children with NRDS treated in the Second People's Hospital of Lianyungang from June 2018 to June 2023 were selected as the research subjects， and were randomly divided into a study group and a control group at 1∶1 ratio. The control group of 50 children received BiPAP treatment， and the study group of 50 children received Caffeine Citrate Injection combination on this basis. The clinical indicators， lung injury indicators [pulmonary surfactant protein A （SP-A）， toll like receptor 2 （TLR-2）， and toll like receptor 4 （TLR-4）]， blood gas indicators [arterial oxygen pressure （PaO2）， arterial carbon dioxide pressure （PaCO2）， and inhaled oxygen concentration （FiO2）]， and complications such as respiratory failure， sepsis， pulmonary hemorrhage， and pneumothorax during treatment were compared between the two groups. Result： After treatment， the clinical indicators， lung injury indicators， and blood gas indicators of the patients in the study group were significantly better than those of the control group （P<0.05）. The incidence of complications such as respiratory failure， sepsis， pulmonary hemorrhage， and pneumothorax in the study group was significantly lower than that of the control group （P<0.05）. Conclusion： The combination of Caffeine Citrate Injection and BiPAP can significantly improve the clinical indicators， lung injury， and blood gas in children with NRDS， and reduce the incidence of complications， showing a clear therapeutic effect.

[Key words] Caffeine Citrate Injection Bilevel positive airway pressure Neonatal respiratory distress syndrome Clinical indicators Lung injury Blood gas analysis Complications

First-author's address： Department of Neonatology， the Second People's Hospital of Lianyungang， Lianyungang 222023， China

doi：10.3969/j.issn.1674-4985.2024.08.011

新生儿呼吸窘迫综合征（NRDS）是新生儿期常见且严重的呼吸系统疾病，以早产儿和低出生体重儿发病率最高[1]。它主要由肺表面活性物质缺乏导致，常表现为出生后立即或数小时内出现呼吸困难、气促、发绀等症状[2]。双水平正压通气（BiPAP）已广泛应用于NRDS的治疗。BiPAP可以为新生儿提供呼吸支持，改善肺部通氣，降低呼吸工作量。然而，BiPAP治疗仍存在一些局限性，比如治疗效果的差异性，以及可能导致的一些并发症，如气胸、肺出血和败血症等[3]。近年来，枸橼酸咖啡因被逐渐引入NRDS的治疗中。它是一种呼吸兴奋剂，能够刺激新生儿的呼吸中枢，改善呼吸功能，以减少患儿对BiPAP的依赖。然而，枸橼酸咖啡因的疗效和安全性在大规模的临床试验中尚未得到充分验证。……