枸橼酸咖啡因对呼吸窘迫综合征早产儿脑和肠道氧代谢的影响

Effect of Caffeine Citrate on Oxygen Metabolism in Brain and Intestine in Premature Infants with Neonatal Respiratory Distress Syndrome

目的观察枸橼酸咖啡因对呼吸窘迫综合征(RDS)早产儿脑和肠道氧代谢的影响。方法 2015年5月—2016年4月广州市妇女儿童医疗中心新生儿重症监护室收治的胎龄30~34周具有呼吸窘迫综合征的早产儿(71例)生后第2天应用维持量枸橼酸咖啡因,应用近红外光谱法观察治疗前1 h,治疗期间1 h及治疗后1 h脑和肠道局部组织氧代谢变化。结果所有患儿治疗前、治疗期间及治疗后脑氧饱和度(Sc O_2)无明显变化,而治疗期间及治疗后的肠道氧饱和度(Ss O_2)均比治疗前明显升高,治疗期间及治疗后Ss O_2/Sc O_2也明显高于治疗前。咖啡因治疗期间及治疗后Ss O_2/Sc O_2变化率在经鼻呼气末正压通气(n CPAP)下明显高于箱内给氧及呼吸机辅助通气。结论早产儿应用枸橼酸咖啡因可增加局部组织血氧供应,有助于组织氧合,尤其是n CPAP辅助通气的RDS早产儿。

Objective To evaluate the effect of caffeine citrate on oxygen metabolism in brain and intestine in premature infants with neonatal respiratory distress syndrome （ NRDS）. Methods Preterm infants aged 30-34 weeks with NRDS admitted in Guangzhou Women and Children＇s Medical Center during May 2015 and April 2016 were enrolled.They were administrated with maintainance dose of caffeine citrate at the 2nd day after birth.The oxygen metabolism in brain and intestine 1 h before,during and after the administration were recorded by near infrared spectroscopy. Results The cerebral oxygen saturation （Sc02） showed a less significant change before,during and after treatment. While a marked increase was seen in intestinal oxygen saturation （ Ss02） during and after caffeine citrate administration,as well as the change of SsO2/S CO2 than before.Ss02/Sc02 was dramatical higher in infants with nasal continuous positive airway pressure （nCPAP ） than in those with incubator oxygen supply and mechanical ventilation during and after caffeine citrate treatment than before. Conclusion Caffeine citrate may improve the delivery of oxygen and may increase the oxygenation in local tissues for preterm infants with NRDS,especially for infants with nCPAP.