枸橼酸咖啡因治疗新生儿呼吸窘迫综合征的临床研究

Clinical effect of caffeine citrate on respiratory mechanics in neonatal respiratory distress syndrome

目的探究枸橼酸咖啡因治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法将收治的90例NRDS患儿分为枸橼酸咖啡因组和氨茶碱组、对照组,每组各30例,在使用肺表面活性物质(PS,固尔苏)替代治疗及机械通气等基础上,咖啡因组用枸橼酸咖啡因药物进行治疗,氨茶碱组用氨茶碱药物进行治疗,对照组仅给予基础治疗。治疗前后检测患者的呼吸力学变化,治疗后仍无效的患者给予持续的常频机械通气或鼻持续气道正压通气(nCPAP)治疗。结果咖啡因组整体有效率达到86.7%,氨茶碱组整体有效率为73.3%,对照组整体有效为56.7%,咖啡因组明显高于氨茶碱组及对照组(P<0.05);咖啡因组与氨茶碱组、对照组相比,内源性呼气末正压、气道阻力均明显较低(P<0.05),咖啡因组静态顺应性水平明显高于氨茶碱组(P<0.05);咖啡因组机械通气和nCPAP治疗的时间明显短于氨茶碱组及对照组(P<0.05);治疗后,3组的PaCO2和PaO2比较差异有统计学意义(P<0.05),咖啡因组PaCO2最低,PaO2最高。结论使用枸橼酸咖啡因药物方法联合肺表面活性物质治疗呼吸窘迫的新生儿对呼吸力学影响有效。

Objective To investigate the effect of caffeine citrate in treating neonatal respiratory distress syndrome（NRDS）.Methods Ninety cases of NRDS were divided into the caffeine citrate group,aminophylline group and control group,30 cases in each group.On the basis of using pulmonary surfactant（PS,Curosurf）replacement therapy and mechanical ventilation,the caffeine citrate group was treated with caffeine citrate,the aminophylline group was treated with aminophylline and the control group was given the basic treatment.The changes of respiratory mechanics were detected before and after treatment.The invalid cases after treatment were given continuous normal frequency mechanical ventilation or nCPAP.Results The overall effective rate in the caffeine citrate group reached 86.7%,which was 73.3% in the aminophylline group and56.7%in the control group,the caffeine citrate group was significantly higher than the aminophylline group and control group,the difference was statistically significant（P〈0.05）.Compared with the aminophylline group and control group,endogenous end-expiratory pressure and airway resistance in the caffeine citrate group were significantly lower,and the static compliance level in the caffeine citrate group was significantly higher than that in the aminophylline group（P〈0.05）;the mechanical ventilation and nCPAP treatment time in the caffeine citrate group was significantly lower than those in the aminophylline group and control group（P〈0.05）.PaCO2 and PaO2 after treatment had statistical difference among 3 groups（P〈0.05）;PaCO2 in the caffeine citrate group was lowest and PaO2 was highest.Conclusion Using the caffeine citrate medication method combined with PS substance in treatment of NRDS has the effect on respiratory mechanics.