间歇与持续经鼻正压通气治疗新生儿呼吸窘迫综合征的临床疗效比较

Efficiency of nasal intermittent positive pressure ventilation vs nasal continuous positive airway pressure on neonatal respiratory distress syndrome:a prospective,randomized,controlled study

目的比较经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)在新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)中的疗效。方法采用前瞻性随机对照研究的方法,将109例于2008年1月至2009年12月在大坪医院儿科NICU(neonatal intensive care unit)住院的NRDS患儿(男性69例,女性40例)分为NIPPV组(51例)与nCPAP组(58例),观察比较两种方法治疗的时间、治疗前后患儿动脉血气分析结果、氧合指数(oxygenase index,OI)、并发症、治疗后需气管插管行机械通气的比例及预后。结果治疗前两组血气分析、OI差异无显著性(P>0.05),NIPPV组治疗后1h动脉血pH值、p(O2)和OI显著高于nCPAP组(P<0.05)。NIPPV组治疗成功率显著高于nCPAP组(88.2%vs75.9%,P<0.05)。NIPPV组患儿的预后结局中治愈好转出院者显著高于nCPAP组(94.1%vs84.5%,P<0.05)。结论NIPPV可显著降低NRDS患儿气管插管行机械通气的比例,其临床疗效优于nCPAP。

Objective To evaluate the efficiency of nasal intermittent positive pressure ventilation（NIPPV）compared with that of nasal continuous positive airway pressure（nCPAP）on decreasing the possibility for endotracheal ventilation in the treatment of neonatal respiratory distress syndrome（NRDS）.Methods A prospective,randomized,controlled,single-center study was performed on 109 neonatal infants（male 69,female 40）who were admiited in the neonatal intensive care unit of Daping hospital from January 2008 to December 2009.These neonates were randomized into NIPPV group（n=51）and nCPAP group（n=58）.Blood gas analysis,oxygenation index,the duration of respiratory support by NIPPV or nCPAP,and complication occurrence were detected and recorded.The ratio of requirement for endotracheal ventilation and the outcome were investigated.Results There was no signifincat difference between the neonates treated with NIPPV and with nCPAP in comparable clinical conditions at study entry（P〉0.05）.However,at 1 h after treatment,pH value,p（O2）and oxygenase index in NIPPV group were significantly higher than those in nCPAP group（P〈0.05）.More infants did not need endotracheal ventilation when they were treated initially with NIPPV compared with those treated with nCPAP（88.2% vs 75.9%,P〈0.05）.Moreover,NIPPV group had a significant higher ratio of good outcome than nCPAP group（94.1% vs 87.5%,P〈0.05）.Conclusion Both NIPPV and nCPAP decrease the requirement for endotracheal ventilation and improve the outcome in newborn infants suffering from NRDS,but the former has better clinical efficiency.