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目的 探讨枸橼酸咖啡因联合加温湿化高流量鼻导管通气(heated humidified high-flow nasal cannula,HHHFNC)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效及安全性.方法 选择2017年6月至2018年12月收治于东南大学附属徐州医院新生儿重症监护病房的82例胎龄为28～32周的RDS早产儿为研究对象.采用随机数字表法,将其分为联合治疗组(n=42,采用枸橼酸咖啡因联合HHHFNC治疗)及对照组(n=40,采用经鼻持续气道正压通气治疗).采用LSD-t检验、x2检验及Kruskal-Wallis H秩和检验,对两组患儿一般临床资料,呼吸支持后6h、24 h血气分析指标,无创辅助通气时间、总用氧时间、撤机失败率、治疗72 h内气管插管率及呼吸暂停次数等临床疗效,各种并发症及咖啡因药物不良反应等,进行统计学分析.结果 ①两组RDS早产儿的一般临床资料比较,差异均无统计学意义(P＞0.05).②血气分析组内比较结果:两组RDS早产儿呼吸支持后6h、24 h的动脉血pH值、二氧化碳分压(PaCO2)、血氧分压(PaO2)及PaO2/吸入氧体积分数(FiO2)(P/F),均分别较本组早产儿治疗前显著改善,差异均有统计学意义(P＜0.05).联合治疗组RDS早产儿呼吸支持后6h、24 h的PaO2及P/F,均显著高于对照组相应时间点指标,PaCO2则显著低于对照组,差异均有统计学意义(P＜0.05).③联合治疗组RDS早产儿无创辅助通气时间、总用氧时间、撤机失败率、肺表面活性剂使用率、治疗72 h内气管插管率及呼吸暂停次数分别为3.0d(1.0,18.0)d,5.5d(3.0,21.0)d,4例(9.5％),10例(23.8％),3例(7.1％),6.0次(3.0,21.0)次,均显著短于、低于、少于对照组的7.0d(2.0,22.0)d,10.0 d(4.0,28.0)d,11例(27.5％),19例(47.5％),12例(30.0％),15.0次(4.0,28.0)次,差异均有统计学意义(P＜0.05).④联合治疗组RDS早产儿鼻损伤、腹胀及头部塑形发生率等无创呼吸支持相关并发症均显著低于对照组,差异均有统计学意义(P＜0.05).⑤两组RDS早产儿相关并发症及枸橼酸咖啡因药物不良反应发生率比较,差异均无统计学意义(P＞0.05).结论 枸橼酸咖啡因联合HHHFNC治疗早产儿RDS,能有效改善其氧合,缩短无创辅助通气时间,提高撤机成功率,并且减少鼻损伤、腹胀等并发症的发生率.“,”Objective To observe the clinical efficacy and safety of caffeine citrate combined with heated humidified high-flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) in preterm infants.Methods From June 2017 to December 2018,a total of 82 preterm infants with RDS (28 weeks ≤ gestational age＜32 weeks) who were hospitalized in Neonatal Intensive Care Unit of the Affiliated Xuzhou Hospital of Southeast University were chosen as research subjects.They were randomly (random number table method) divided into two groups:the combined treatment group (n=42) and the control group (n=40).Infants in the combined treatment group were given caffeine citrate combined with HHHFNC,while infants in the control group were given nasal continuous positive airway pressure (NCPAP) without caffeine citrate.The general clinical data,results of blood gas analysis at 6 h and 24 h after breath support therapy,clinical efficacy,related complications and adverse drug reactions between the two groups were compared statistically by LSD-t test,Chi-square test and Kruskal-Wallis H rank sum test.Results ① No significant differences were found between the two groups in the general clinical data (all P＞0.05).② The results of intra-groups comparison within the combined treatment group or control group showed that the pH value,partial pressure of arterial carbon dioxide (PaCO2),partial pressure of arterial oxygen (PaO2) of blood gas analysis and PaO2/fraction of inspired oxygen (P/F) at 6 h and 24 h after breath support therapy were all significantly improved compared to those of before treatment (all P＜0.05);The PaO2 and P/F of premature infants in the combined treatment group at 6 h and 24 h after breath support therapy were significantly higher than those in the control group,while PaCO2 were significantly lower than that in the control group (all P＜0.05).③ The duration of noninvasive ventilation,total oxygen inhaling,failure rate of machine withdrawal,use of pulmonary surfactants,the rate of tracheal intubation within 72 h and the times of apnea in combined treatment group were 3.0 d (1.0,18.0)d,5.5 d (3.0,21.0)d,4 case(9.5％),10 case(23.8％),3 case(7.1％) and 6.0 times(3.0,21.0)times,which were significant shorter,or lower,or less than those in control group,which were 7.0 d (2.0,22.0),10.0 d (4.0,28.0),11 case(27.5％),19 case(47.5％),12 case(30.0％)and 15.0 times(4.0,28.0)times,and the differences were all statistically significant (all P＜0.05).④ The occurrence of nasal trauma,abdominal distention and head shaping in the combined treatment group were significantly lower than those in the control group (all P＜0.05).⑤ There were no significant differences between the two groups of premature infants in related complication and caffeine associated adverse reactions (all P＞0.05).Conclusions Caffeine citrate combined with HHHFNC treatment strategy for premature infants with RDS can effectively improve oxygenation,shorten the duration of noninvasive mechanical ventilation,increase the success rate of machine withdrawal,and reduce the incidence of nasal trauma and abdominal distention.