早产儿机械通气撤机后应用鼻塞持续气道正压通气对呼吸支持的评估

Evaluation of nasal continuous positive airway pressure in premature infants after ventilator weaning.

【目的】探讨鼻塞持续气道正压通气(nasal continuous positive airway pressure,NCPAP)在防止早产儿撤离经气管插管机械通气时撤机失败的作用。【方法】将48例体重<2 000 g,胎龄≤32周,进行经气管插管机械通气的早产儿在撤机后随机分成NCPAP组(24例)及经头罩给氧组(24例)。撤机72 h病情稳定视为撤机成功。比较两组的撤机成功率。【结果】撤机后NCPAP组19例一次撤机成功(79.2%),直接头罩给氧组一次成功仅10例(41.7%),两组间差异具有显著性(P<0.01)。两组间出现腹胀、喂养不耐受情况,差异无显著性(P>0.05)。撤机失败的主要原因经头罩给氧组是呼吸暂停,PaCO2升高和FiO2升高,而NCPAP组则为PaCO2升高和FiO2升高。【结论】早产儿撤离经气管插管机械通气后立即使用NCPAP支持呼吸,可明显提高一次撤机成功率。

[Objective] To determine whether nasal continuous positive airway pressure （NCPAP） prevents extubation failure in premature infants. [Methods] Forty-eight premature infants,（〈2 000 g birth weight and ≤32 weeks gestation） who were beeing mechanically ventilated were enrolled in the study. The infants were randomized at extubation to either NCPAP or O2 via head box（24 per group）. Extubation success or failure was defined as reintubation within 72 hours of extubation. The success rates were compared between the two groups. Objective criteria for failure of extubation were as follow： a PaCO2 〉70mmHg; FiO2 〉0.7 ;or severe recurrent apnea （〉2 apnea requiring intermittent positive pressure ventilation in 24 hours or 〉6 apnea per day）. [Results] The NCPAP group had a higher incidence of extubation success （19/24） compared with head box group（10/24）. There was no increase in the incidence of abdominal distensionor feeding intolerance. In head box group, extubation failed because of severe apnea, elevated PaCO2 and FiO2. Failed because of elevated PaCO2 and FiO2 in NCPAP group, [Conelusion] NCPAP immediately after extubation is effective in preventing extubation failure and can increase the success rate of ventilator weaning in premature infants.