摘要
目的比较不同疗程枸橼酸咖啡因联合肺表面活性物质治疗早产儿呼吸窘迫综合征(RDS)的临床疗效。方法选取连云港市第一人民医院2023年6月至2024年12月收治的84例RDS早产患儿,采用随机数字表法分为对照组和试验组,每组42例。两组均采用枸橼酸咖啡因联合牛肺表面活性剂治疗,对照组持续治疗至纠正胎龄33~34周,试验组持续治疗至纠正胎龄36周。观察并比较两组的临床疗效、治疗情况、血气指标、炎症指标及不良反应和并发症发生情况。结果试验组和对照组的治疗总有效率为90.48%(38/42)和85.71%(36/42),差异无统计学意义(χ^(2)=0.454,P>0.05)。两组肺表面活性物质追加率差异无统计学意义(χ^(2)=0.105,P>0.05),试验组住院时间、呼吸机使用时间、用氧时间[(32.27±3.73)d、(2.42±0.64)d、(8.73±1.62)h]均低于对照组[(35.34±3.57)d、(3.02±0.87)d、(9.63±1.42)h](t=3.853、3.600、2.708,均P<0.05)。治疗后,试验组动脉氧分压、血氧饱和度、pH值水平[(89.41±5.27)mmHg(1 mmHg=0.133 kPa)、(87.56±5.32)%、(7.45±0.09)]均高于对照组[(85.52±5.82)mm Hg、(83.52±5.27)%、(7.33±0.08)](t=3.211、3.496、6.458,均P<0.05),动脉二氧化碳分压水平[(36.51±3.53)mmHg]低于对照组[(39.51±3.66)mmHg](t=3.823,P<0.05)。治疗后,试验组C反应蛋白、降钙素原水平[(13.82±2.85)mg/L、(11.84±2.43)μg/L]均低于对照组[(16.31±2.72)mg/L、(13.73±2.53)μg/L](t=4.096、3.492,均P<0.05)。对照组和试验组并发症发生率分别为42.86%(18/42)和21.43%(9/42)(χ^(2)=4.421,P<0.05);不良反应发生率分别为9.52%(4/42)和11.90%(5/42),经Fisher确切概率法检验,组间差异无统计学意义(P=1.000)。结论枸橼酸咖啡因联合肺表面活性物质治疗早产儿RDS,用药至纠正胎龄36周时不会明显影响临床疗效,能有效改善血气水平,抑制炎症反应,减少并发症,安全性较好。
Objective To compare the clinical efficacy of different treatment courses of caffeine citrate combined with pulmonary surfactant in the treatment of preterm infants with respiratory distress syndrome(RDS).Methods A total of 84 premature infants with RDS admitted to the First People’s Hospital of Lianyungang from June 2023 to December 2024 were enrolled and randomly divided into the control group and the experimental group using the random number table method,with 42 cases in each group.Both groups were treated with caffeine citrate and bovine pulmonary surfactant.The control group received continuous treatment until a corrected gestational age of 33-34 weeks,while the experimental group received continuous treatment until a corrected gestational age of 36 weeks.Clinical efficacy,treatment status,blood gas indicators,inflammatory markers,and the incidence of adverse reactions and complications were observed and compared between the two groups.Results The total effective rates were 90.48%(38/42)in the experimental group and 85.71%(36/42)in the control group,with no statistically significant difference(χ^(2)=0.454,P>0.05).There was no statistically significant difference in the rate of additional pulmonary surfactant administration between the two groups(χ^(2)=0.105,P>0.05).The hospital stay,duration of ventilator use,and oxygen therapy time in the experimental group((32.27±3.73)days,(2.42±0.64)days,(8.73±1.62)hours,respectively)were significantly shorter than those in the control group((35.34±3.57)days,(3.02±0.87)days,(9.63±1.42)hours,respectively)(t=3.853,3.600,2.708,all P<0.05).After treatment,the levels of arterial partial pressure of oxygen(PaO2),oxygen saturation(SpO_(2)),and pH in the experimental group((89.41±5.27)mmHg(1 mmHg=0.133 kPa),(87.56±5.32)%,(7.45±0.09),respectively)were all higher than those in the control group((85.52±5.82)mmHg,(83.52±5.27)%,(7.33±0.08),respectively)(t=3.211,3.496,6.458,all P<0.05).The arterial partial pressure of carbon dioxide(PaCO_(2))level in the experimental group((36.51±3.53)mmHg)was lower than that in the control group((39.51±3.66)mmHg)(t=3.823,P<0.05).After treatment,the levels of C-reactive protein(CRP)and procalcitonin(PCT)in the experimental group((13.82±2.85)mg/L and(11.84±2.43)μg/L,respectively)were lower than those in the control group((16.31±2.72)mg/L and(13.73±2.53)μg/L,respectively)(t=4.096,3.492,both P<0.05).The incidence of complications in the control group and the experimental group were 42.86%(18/42)and 21.43%(9/42),with a statistically significant difference(χ^(2)=4.421,P<0.05),and the incidence of adverse reactions were 9.52%(4/42)in the control group and 11.90%(5/42)in the experimental group,with no statistically significant difference between the groups by Fisher’s exact test(P=1.000).Conclusion For preterm infants with RDS treated with caffeine citrate combined with pulmonary surfactant,extending the treatment duration until a corrected gestational age of 36 weeks does not significantly affect clinical efficacy.This longer regimen can effectively improve blood gas parameters,suppress inflammatory responses,reduce complications,and demonstrate a favorable safety profile.
作者
赵娟
侍海棠
ZHAO Juan;SHI Haitang(Department of Neonatology,The First People’s Hospital of Lianyungang,Lianyungang 222006,China)
出处
《中国药物应用与监测》
2025年第9期1589-1593,共5页
Chinese Journal of Drug Application and Monitoring
