低侵入微创给予肺表面活性物质联合枸橼酸咖啡因治疗新生儿呼吸窘迫综合征的效果及对血气指标通气时间的影响

doi:10.3969/j.issn.1006-6233.2023.08.020

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摘要 目的: 探究低侵入微创给予肺表面活性物质(LISA)联合枸橼酸咖啡因在新生儿呼吸窘迫综合征(NRDS)中的疗效及对血气指标、通气时间的影响。方法: 选取我院2020年9月到2022年9月收治的143例NRDS患儿,按双色球随机分组法分为联用组(n=72,LISA联合枸橼酸咖啡因治疗)和常规组(n=71,LISA治疗)。比较两组临床疗效、呼吸力学指标[内源性呼气末正压、气道阻力、静态顺应性]、血气指标[二氧化碳分压(PaCO₂)、氧分压(PaO₂)、血酸碱度(pH)值]、机械通气时间、氧疗时间、呼吸暂停、治疗并发症等情况。结果: 两组治疗总有效率比较差异无统计学意义(P>0.05),但联用组治疗显效率高于常规组(P<0.05);两组治疗后内源性呼气末正压及气道阻力均低于治疗前,静态顺应性高于治疗前,且联用组治疗前后内源性呼气末正压、气道阻力及静态顺应性变化幅度均大于常规组(P<0.05);两组治疗后PaCO₂低于治疗前,PaO₂及pH值高于治疗前,且联用组治疗前后PaCO₂及PaO₂变化幅度大于常规组(P<0.05);联用组机械通气时间、氧疗时间及呼吸暂停次数均少于常规组(P<0.05);联用组患儿出现支气管肺发育不良及呼吸机相关性肺炎发生率低于常规组(P<0.05)。结论: LISA联合枸橼酸咖啡因治疗NRDS的效果显著,可明显改善患儿血气分析指标,缩短通气时间,安全性较好,值得临床推广应用。

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关键词 ：新生儿呼吸窘迫综合征, 低侵入微创给予肺表面活性物质技术, 枸橼酸咖啡因, 血气分析, 机械通气

Abstract：Objective: To explore the effect of less invasive surfactant administration (LISA) combined with caffeine citrate in the treatment of neonatal respiratory distress syndrome (NRDS) and its influence on blood gas indicators and ventilation time. Methods: A total of 143 children with NRDS admitted to the hospital from September 2020 to September 2022 were selected and divided into combination group (n=72, LISA combined with caffeine citrate treatment) and conventional group (n=71, LISA treatment) according to the two-color sphere random grouping method. The clinical efficacy, respiratory mechanics indicators [endogenous positive end-expiratory pressure, airway resistance, static compliance], blood gas indicators [partial pressure of carbon dioxide (PaCO₂), partial pressure of oxygen (PaO₂), blood power of hydrogen (pH) value], mechanical ventilation time, oxygen therapy time, apnea and treatment complications were compared between the two groups. Results: There was no statistical difference in the overall effective rate between the two groups (P>0.05), but the markedly effective rate in combination group was higher than that in conventional group (P<0.05). After treatment, the endogenous positive end expiratory pressure and airway resistance in both groups were lower than before treatment, while static compliance was higher than before treatment (P<0.05). Moreover, the amplitude of changes in endogenous positive end expiratory pressure, airway resistance, and static compliance in the combination group before and after treatment was greater than that in the conventional group (P<0.05). After treatment, the PaCO₂ levels in both groups were lower than before treatment, while the PaO₂ and pH values were higher than before treatment (P<0.05). Moreover, the changes in PaCO₂ and PaO₂ levels in the combination group before and after treatment were greater than those in the conventional group (P<0.05). The mechanical ventilation time, oxygen therapy time, and apnea frequency in combination group were shorter or less than those in conventional group (P<0.05). The incidence rates of bronchopulmonary dysplasia and ventilator-associated pneumonia in combination group were lower than those in conventional group (P<0.05). Conclusion: LISA combined with caffeine citrate has a significant effect in the treatment of NRDS, and it can obviously improve the blood gas analysis indicators and shorten the ventilation time, and it has good safety and is worthy of clinical promotion and application.

Key words： Neonatal respiratory distress syndrome Less invasive surfactant administration Caffeine citrate Blood gas analysis Mechanical ventilation

基金资助:海南省卫生计生行业科研项目,(编号:16A200012)

引用本文:

蔡枚龄, 羊才进, 羊威, 杨路, 陈焕秋, 符红波. 低侵入微创给予肺表面活性物质联合枸橼酸咖啡因治疗新生儿呼吸窘迫综合征的效果及对血气指标通气时间的影响[J]. 河北医学, 2023, 29(8): 1335-1340.
CAI Meiling, YANG Caijin, YANG Wei, et al. Effect of Less Invasive Surfactant Administration Combined with Caffeine Citrate on Neonatal Respiratory Distress Syndrome and Its Influence on Blood Gas Indicators and Ventilation Time. HeBei Med, 2023, 29(8): 1335-1340.

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http://www.hbyxzzs.cn/CN/10.3969/j.issn.1006-6233.2023.08.020 或 http://www.hbyxzzs.cn/CN/Y2023/V29/I8/1335

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