高频震荡通气联合枸橼酸咖啡因注射液治疗新生儿呼吸窘迫综合征的疗效及对心肌损伤标志物和氧化应激的影响

Efficacy of high frequency oscillatory ventilation combined with caffeine citrate injection in the treatment of neonatal respiratory distress syndrome and its effects on myocardial injury markers and oxidative stress

目的探讨高频震荡通气(HFOV)联合枸橼酸咖啡因治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法前瞻性将2021年1月至2023年12月收治于成都市妇女儿童中心医院的NRDS患儿118例作为研究对象。按照随机数字表法将患者分为观察组和对照组,每组各59例。对照组予以HFOV通气治疗,观察组予以HFOV通气联合枸橼酸咖啡因治疗。治疗7 d后,对两组患儿进行疗效评价;比较两组机械通气时间、用氧时间、呼吸暂停次数,并比较两组治疗前和治疗7 d后的血气指标、心肌损伤指标[肌酸激酶同工酶(CK-MB)、乳酸脱氢酶(LDH)]和氧化应激指标[超氧化物歧化酶(SOD)、丙二醛]水平;统计并比较两组并发症情况。结果治疗7 d后,观察组的总有效率为94.92%,高于对照组(81.36%),差异有统计学意义(P<0.05)。观察组机械通气时间、用氧时间分别为(5.37±1.42)、(7.13±1.39)d,均短于对照组[(6.48±1.51)、(8.44±1.54)d],呼吸暂停次数为(5.17±0.87)次,少于对照组[(6.89±1.25)次],差异均有统计学意义(P<0.05)。观察组治疗7 d后的PaO_(2)和氧合指数分别为(72.69±6.31)mmHg、116.58±9.41,均高于对照组[(67.89±5.96)mmHg、105.78±10.21],PaCO_(2)为(41.88±5.31)mmHg,低于对照组[(44.89±4.97)mmHg],差异均有统计学意义(P<0.05)。观察组治疗7 d后的血清CK-MB、LDH水平分别为(34.55±3.55)、(281.36±42.47)U/L,均低于对照组[(41.78±5.36)、(349.41±46.51)U/L],差异均有统计学意义(P<0.05)。观察组治疗7 d后的血清SOD水平为(27.62±5.78)U/mL,高于对照组[(24.31±5.21)U/mL],丙二醛水平为(23.45±3.24)μmol/L,低于对照组[(30.48±3.96)μmol/L],差异均有统计学意义(P<0.05)。观察组与对照组的总并发症发生率分别为7例(11.86%)、13例(22.03%),两组比较差异无统计学意义(P>0.05)。结论HFOV联合枸橼酸咖啡因治疗NRDS有较好疗效,能够改善血气指标,减轻心肌损伤和氧化应激。

Objective To investigate the efficacy of high frequency oscillatory ventilation(HFOV)combined with caffeine citrate injection in the treatment of neonatal respiratory distress syndrome(NRDS).Methods A prospective study was conducted on 118 children with NRDS admitted to Chengdu Women's and Children's Center Hospital from January 2021 to December 2023.According to the random number table method,patients were divided into an observation group and a control group,with 59 cases in each group.The control group was treated with HFOV ventilation,and the observation group was treated with HFOV ventilation combined with caffeine citrate injection.After 7 days of treatment,the efficacy of the two groups was evaluated.The mechanical ventilation time and oxygen use time were compared between the two groups,and the blood gas indexes,myocardial injury indexes[creatine kinase isoenzyme(CK-MB),lactate dehydrogenase(LDH)]and oxidative stress indexes[superoxide dismutase(SOD),malondialdehyde]before treatment and after 7 days of treatment were compared between the two groups.The complications of the two groups were counted and compared.Results After 7 days of treatment,the total effective rate of the observation group was 94.92%,which was higher than that of the control group(81.36%),and the difference was statistically significant(P<0.05).The mechanical ventilation time and oxygen usage time in the observation group were(5.37±1.42)and(7.13±1.39)d,respectively,which were shorter than those in the control group[(6.48±1.51)and(8.44±1.54)d].The number of respiratory pauses was(5.17±0.87)times,which was lower than that in the control group[(6.89±1.25)times],and the differences were statistically significant(P<0.05).After 7 days of treatment,the PaO_(2)and oxygenation index of the observation group were(72.69±6.31)mmHg and 116.58±9.41,respectively,which were higher than those of the control group[(67.89±5.96)mmHg and 105.78±10.21],the PaCO_(2)was(41.88±5.31)mmHg,which was lower than that of the control group[(44.89±4.97)mmHg],and the differences were statistically significant(P<0.05).After 7 days of treatment,the serum CK-MB and LDH levels in the observation group were(34.55±3.55)and(281.36±42.47)U/L,respectively,which were lower than those in the control group[(41.78±5.36)and(349.41±46.51)U/L],and the differences were statistically significant(P<0.05).After 7 days of treatment,the serum SOD level in the observation group was(27.62±5.78)U/mL,higher than that in the control group[(24.31±5.21)U/mL],and the malondialdehyde level was(23.45±3.24)μmol/L,which was lower than that in the control group[(30.48±3.96)μmol/L],and the differences were statistically significant(P<0.05).The total incidence of complications between the observation group and the control group was 7(11.86%),13(22.03%).There was no statistically significant difference(P>0.05).Conclusion HFOV combined with caffeine citrate is effective in the treatment of NRDS,which can improve blood gas indexes,reduce myocardial injury and oxidative stress.