经鼻持续气道正压通气在28～32周早产儿呼吸窘迫综合征中的预防应用

The application of prophylactic nasal continuous airway positive pressure on respiratory distress syndrome in preterm newborns of 28-32 gestational weeks

目的探讨早期经鼻持续气道正压通气(nCPAP)对28～32周极低出生体重儿呼吸窘迫综合征(RDS)的预防作用。方法72例胎龄28～32周的早产儿随机分为观察组和对照组,观察组患儿在出生后30min内无论有无缺氧均予以nCPAP进行呼吸管理,对照组患儿只有在吸氧浓度(FiO2)>40%,经皮血氧饱和度(TcSO2)波动于93%～96%,持续30min以上时予以nCPAP。当FiO2≥40%,患儿TcSO2波动于93%～96%,持续30min以上,胸部X线同时有RDS征象时,予以一剂外源性肺表面活性物质(PS)。观察两组患儿RDS的发生率、PS和机械通气的使用率。结果观察组RDS发生率为45.0%(18/40),明显低于对照组68.8%(22/32)(P<0.05),差异有统计学意义,Ⅰ～Ⅱ级RDS的发生率两组比较差异有统计学意义(P<0.05),Ⅲ～Ⅳ级RDS的发生率两组比较差异无统计学意义(P>0.05);观察组25%(10/40)需应用PS,明显少于对照组50%(16/32),差异有统计学意义(P<0.05);观察组生后72h内机械通气率47.5%(19/40),对照组71.9%(23/32),差异有统计学意义(P<0.05);颅内出血的发病率两组相比差异无统计学意义(P>0.05)。结论nCPAP是一种无创性技术,对28～32周极低出生体重儿RDS有明显的疗效,早期应用nCPAP对RDS有一定的预防作用,能减少外源性PS的应用以及减少对机械通气的需要。

Objective To investigate the prophylactic role of early nasal continuous positive airway pressure（nCPAP）on respiratory distress syndrome（RDS）in the extremely low birth weight infants of 28-32 gestational weeks.Methods A total of 72 eligible infants of 28-32 gestational weeks were randomly allocated to prophylactic（observe group）or therapeutic（control group）nCPAP.Prophylactic nCPAP was started within 30 minutes of birth,irrespective of oxygen requirement and clinical status.Therapeutic nCPAP was started when FiO2 requirement was 〉 0.4,for more than 30 minutes,to maintain transcutaneous oxygen saturation between 93% and 96%.Exogenous surfactant was given when FiO2 requirement was 〉 0.4 in nCPAP in the presence of radiological signs of respiratory distress syndrome.Observe the incidence of RDS and the administration of exogenous surfactant（PS）and mechanical ventilation as well.Results The incidence of RDS in observe group was significatly lower than that of control group（45.0% vs 68.8%,P〈0.05）,and the incidence of gradeⅠ～Ⅱ RDS in observe group was significantly lower than that of control group（P〈0.05）,but the incidence of grade Ⅲ～Ⅳ RDS was not significantly difference between two groups（P〉0.05）.However,that the need for surfactant was 25% in observe group and 50% in control group（P〈0.05）.The need of mechanical ventilation in first 72 hours of life in observe group was significatly lower than that of control group（47.5% vs 71.9%,P〈0.05）.While no significant difference at the incidence of intracranial hemorrhage was found（P〉0.05）.Conclusion nCPAP is a non invasive method with benefits in the treatment of the RDS in preterm newborn of 28-32 gestational weeks.Using early nCPAP may have some benefits as prophylaxis for RDS and reduce the necessity for surfactant and mechanical ventilation.