目的 探讨牛肺表面活性剂联合咖啡因治疗新生儿呼吸窘迫综合征的临床效果。方法 选取2019年8月—2020年7月天津市中心妇产科医院收治的86例NCPAP辅助呼吸治疗下需氧浓度≤0.3的新生儿呼吸窘迫综合征患儿，运用随机数字表法将其随机分成对照组（n=43）和治疗组（n=43）。对照组使用输液泵静脉输注枸橼酸咖啡因注射液，以20 mg/kg为首剂量，静脉输注30 min，间隔24 h后，每次给予5 mg/kg的维持剂量，每次给药时间为10 min，1次/d。治疗组在对照组基础上予以气管内注射注射用牛肺表面活性剂，剂量为100 mg/kg，后根据患儿的病情，必要时可于上次用药后6～24 h重复给药。两组治疗7 d后评价疗效。观察两组的临床疗效，比较治疗前后两组血气指标及血清肿瘤坏死因子（TNF）-α、白介素（IL）-6、内皮素（ET）-1和转化生长因子（TGF）-β1水平；并比较两组机械通气时间、总用氧时间及住院时间及并发症发生情况。结果 治疗后，治疗组总有效率是93.0%，显著高于对照组的76.7%（P<0.05）。两组治疗后动脉血氧分压（pO₂）、pH值及碱剩余（BE）均较本组治疗前显著增加（P<0.05），但pCO₂均显著降低（P<0.05）；且治疗后，治疗组血气指标改善优于对照组（P<0.05）。治疗后，两组血清TNF-α、IL-6、ET-1及TGF-β1水平均较本组治疗前显著降低（P<0.05）；且治疗后，治疗组血清学指标水平低于对照组（P<0.05）。治疗过程中，治疗组机械通气时间、总用氧时间及住院时间均显著短于对照组（P<0.05）。治疗后，治疗组并发症发生率为4.7%，显著低于对照组的18.6%（P<0.05）。结论 牛肺表面活性剂联合咖啡因治疗新生儿呼吸窘迫综合征的总体疗效满意，可安全有效地改善患儿血气状态，抑制机体炎症反应，有利于迅速控制患儿病情。

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

国家自然科学基金青年项目（81800634）