经鼻间歇正压通气辅助呼吸治疗早产儿呼吸窘迫综合征

Nasal Intermittent Positive Pressure Ventilation in Preterm Infants with Respiratory Distress Syndrome

目的探讨经鼻间歇正压通气(NIPPV)治疗早产儿呼吸窘迫综合征(RDS)的疗效及安全性。方法将2010年1-12月本院收治的胎龄小于34周RDS早产儿30例设为NIPPV组,并将2009年3月-2010年11月随机抽取的胎龄小于34周RDS早产儿30例作为经鼻持续正压通气(NCPAP)组,2组患儿胎龄、出生体质量比较差异均无统计学意义。诊断RDSⅢ～Ⅳ级,无严重并发症,均接受肺表面活性物质治疗。结果 NIPPV组辅助通气时间较NCPAP组明显缩短(P<0.05)。机械通气率NIPPV组明显低于NCPAP组,且病死率及肺气漏无增加。2 h时,2组呼吸机工作参数比较无统计学差异(P>0.05),12 h、24 h和36 h时比较差异均有统计学意义(Pa<0.05),12 h、24 h和36 h时吸氧体积分数比较差异均有统计学意义(Pa<0.05)。呼气末正压12 h、24 h和36 h时比较差异均有统计学意义(Pa<0.05)。2组2 h时pH比较无统计学差异(P>0.05),而12 h、24 h和36 h时pH的差异均有统计学意义。12 h时动脉血氧分压比较无统计学差异(P>0.05),而24 h和36 h均有统计学差异(Pa<0.05)。NIPPV组极低体质量儿及超极低出生体质量儿12例,NCPAP组10例,均未发生支气管肺发育不全。结论与NCPAP比较,NIPPV治疗RDS有较好疗效,且可减少RDS患儿的气管再插管和机械通气。

Objective To determine whether nasal intermittent positive pressure ventilation（NIPPV） was available and safe for preterm infants with respiratory distress syndrome（RDS）. Methods The study was carried out from Jan.to Dec.2010 at the Fourth Hospital of Shijia-zhuang City,and 30 cases with clinical signs of RDS were given a trial of NIPPV.In comparison to the cases from Mar.2009 to Nov.2010,34 cases with RDS were assigned randomly as nasal continuous positive airway pressure（NCPAP）,with the neonatal gestation age30 weeks.There were no statistical differences in neonatal gestation age and birth weight between the both groups.They were diagnosed as RDS（stage Ⅲ-Ⅳ） and received pulmonary surfactant treatment;no severe complications were found. Results The duration of NIPPV was significantly shorter than that of NCPAP（P0.05）.Mechanical ventilation rate by NIPPV was less than that by NCPAP,and there was no increase in mortality rate and pneumothorax.The ventilator parameters at 2 h between the NIPPV and the NCPAP groups were not statistically different（P0.05）,but the ventilator parameters had statistically significant differences at 12 h,24 h and 36 h.In both groups,fraction of inspiration O2 at 12 h,24 h and 36 h,was statistically different（Pa0.05）;positive end-expiratory pressure at 12 h,24 h and 36 h was statistically different（P0.05）;there was no difference of pH ratio at 2 h（P0.05）,but there was statistical difference of pH ratio at 12 h,24 h and 36 h between both groups.Arterial blood oxygen pressure at 12 h was not statistically different（P0.05）,but it was statistically different at 24 h and 36 h（Pa0.05）.There was no incidence of bronchopulmonary dysplasia in 12 cases with very low birth weight infants by NIPPV and in 10 cases with extra low birth weight infants by NCPAP. Conclusions Among preterm infants with RDS,the use of NIPPV is effective,and reintubation and mechanical ventilation are not needed compared to the use of NCPAP.