不同PEEP水平的鼻塞持续正压通气对早产儿反复呼吸暂停的疗效观察

Therapeutic effects of nasal continuous positive airway pressure with different PEEP levels on recurrent apnea in premature infants

目的观察和比较不同呼吸末正压(PEEP)水平的鼻塞持续正压通气(NCPAP)对早产儿反复呼吸暂停的治疗效果。方法对76例出生后发生反复呼吸暂停且胎龄≤34周的早产儿实施NCPAP治疗。患儿根据PEEP的不同设置分为低(2～3cmH2O)、中(4～6cmH2O)、高(7～8cmH2O)PEEP组。观察和比较三组的治疗效果及并发症发生情况。结果 76例患儿中共65例进入结果分析。低、中、高PEEP组的治疗有效率分别为57.1%、92.3%和91.7%,实施气管插管机械通气早产儿的百分比分别为42.9%、7.7%和8.3%;统计学分析表明,中、高PEEP组治疗有效率显著高于低PEEP组,而实施气管插管机械通气早产儿的百分比明显低于低PEEP组(P<0.05)。高PEEP组气漏发生率为33.3%,明显高于低、中PEEP组的0%和7.7%(P<0.05)。结论当PEEP设置在4～6cmH2O时,NCPAP治疗早产儿反复呼吸暂停的疗效显著且并发症发生率较低。

Objective To investigate the therapeutic effects of nasal continuous positive airway pressure （NCPAP） with different positive end expiratory pressure （PEEP） levels on recurrent apnea in premature infants. Methods NCPAP treatment was performed on 76 infants with recurrent apnea after birth and gestational age ≤34 weeks. Patients were divided into low PEEP group （PEEP 2-3 cmH2O）, medium PEEP group （PEEP 4-6 cmH2O） and high PEEP group （PEEP 7-8 cmH2O）. The therapeutic effects and prevalences of complications were compared among groups.Results Sixty-five out of 76 patients entered statistical analysis. The therapeutic effects of low PEEP group, medium PEEP group and high PEEP group were 57.1%, 92.3% and 91.7%, respectively, and the percentages of mechanical ventilation with tracheal intubation were 42.9%, 7.7% and 8.3%, respectively. The therapeutic effects were significantly higher and the percentages of mechanical ventilation with tracheal intubation were significantly lower in high PEEP group and medium PEEP group than in low PEEP group （P〈0.05）. The prevalence of air leak in high PEEP group was 33.3%, and was significantly higher than those of low PEEP group （0%） and medium PEEP group （7.7%） （P〈0.05）. Conclusion At PEEP of 4-6 cm H2O, NCPAP treatment may yield favorable therapeutic effects with lower prevalence of complications on recurrent apnea in premature infants.