目的 探討牛肺表面活性劑聯(lián)合咖啡因治療新生兒呼吸窘迫綜合征的臨床效果。方法 選取2019年8月—2020年7月天津市中心婦產(chǎn)科醫(yī)院收治的86例NCPAP輔助呼吸治療下需氧濃度≤0.3的新生兒呼吸窘迫綜合征患兒，運用隨機數(shù)字表法將其隨機分成對照組（n=43）和治療組（n=43）。對照組使用輸液泵靜脈輸注枸櫞酸咖啡因注射液，以20 mg/kg為首劑量，靜脈輸注30 min，間隔24 h后，每次給予5 mg/kg的維持劑量，每次給藥時間為10 min，1次/d。治療組在對照組基礎上予以氣管內(nèi)注射注射用牛肺表面活性劑，劑量為100 mg/kg，后根據(jù)患兒的病情，必要時可于上次用藥后6～24 h重復給藥。兩組治療7 d后評價療效。觀察兩組的臨床療效，比較治療前后兩組血氣指標及血清腫瘤壞死因子（TNF）-α、白介素（IL）-6、內(nèi)皮素（ET）-1和轉(zhuǎn)化生長因子（TGF）-β1水平；并比較兩組機械通氣時間、總用氧時間及住院時間及并發(fā)癥發(fā)生情況。結(jié)果 治療后，治療組總有效率是93.0%，顯著高于對照組的76.7%（P<0.05）。兩組治療后動脈血氧分壓（pO₂）、pH值及堿剩余（BE）均較本組治療前顯著增加（P<0.05），但pCO₂均顯著降低（P<0.05）；且治療后，治療組血氣指標改善優(yōu)于對照組（P<0.05）。治療后，兩組血清TNF-α、IL-6、ET-1及TGF-β1水平均較本組治療前顯著降低（P<0.05）；且治療后，治療組血清學指標水平低于對照組（P<0.05）。治療過程中，治療組機械通氣時間、總用氧時間及住院時間均顯著短于對照組（P<0.05）。治療后，治療組并發(fā)癥發(fā)生率為4.7%，顯著低于對照組的18.6%（P<0.05）。結(jié)論 牛肺表面活性劑聯(lián)合咖啡因治療新生兒呼吸窘迫綜合征的總體療效滿意，可安全有效地改善患兒血氣狀態(tài)，抑制機體炎癥反應，有利于迅速控制患兒病情。

Objective To investigate the clinical effect of bovine lung surfactant combined with caffeine in treatment of neonatal respiratory distress syndrome. Methods A total of 86 infants with neonatal respiratory distress syndrome which NCPAP FiO₂ ≤ 0.3 admitted to Tianjin Central Hospital of Obstetrics and Gynecology from August 2019 to July 2020 were selected and randomly divided into control group (n=43) and treatment group (n=43) using the random number table method. Patients in the control group received intravenous infusion of Caffeine Citrate Injection with an infusion pump, starting with 20 mg/kg, intravenous infusion for 30 min, 24 h later, 5 mg/kg maintenance dosage was given each time, 10 min, once daily. Patients in the treatment group were given intracheal injection of Calf Pulmonary Surfactant for injection at a dosage of 100 mg/kg on the basis of the treatment group, and the drug could be repeated 6 — 24 h after the last treatment if necessary according to the condition of the children. The efficacy of the two groups was evaluated after 7 days of treatment. After treatment, the clinical efficacy was evaluated, and the levels of blood gas indexes, serum levels of tumor necrosis factor (TNF-α), interleukin (IL-6), endothelin (ET)-1, and transforming growth factor (TGF-β1) were compared before and after treatment. The mechanical ventilation time, total oxygen use time, hospital stay and the incidence of complications were compared between the two groups. Results After treatment, the total effective rate of the treatment group was 93.0%, which was significantly higher than that of the control group (76.7%, P < 0.05). After treatment, pO₂, pH and BE in two groups were significantly increased compared with before treatment (P < 0.05), but pCO₂ was significantly decreased (P < 0.05). After treatment, the improvement of blood gas indexes in treatment group was better than that in control group (P < 0.05). After treatment, the serum levels of TNF-α, IL-6, ET-1, and TGF-β1 in two groups were significantly decreased compared with before treatment (P < 0.05). After treatment, the serum indexes in the treatment group were lower than those in the control group (P < 0.05). During the course of treatment, the mechanical ventilation time, total oxygen use time and hospital stay time in the treatment group were significantly shorter than those in the control group (P < 0.05). After treatment, the complication rate of the treatment group was 4.7%, which was significantly lower than that of the control group (18.6%, P < 0.05). Conclusion Bovine lung surfactant combined with caffeine has overall curative effect in treatment of neonatal respiratory distress syndrome, and can safely and safely and effectively improve the blood gas state of children, inhibit the inflammatory response of the body, and is beneficial to the rapid control of the children's condition.

R974

國家自然科學基金青年項目（81800634）