不同无创正压通气对呼吸窘迫综合征早产儿血气及疗效的影响

Comparison of the blood gas and curative effect in preterm infants of respiratory distress syndrome with different modes of noninvasive positive pressure ventilation

目的比较双水平气道正压通气（BiPAP）和鼻塞式持续气道正压通气（NCPAP）对呼吸窘迫综合征（RDS）早产儿血气及疗效的影响，以评价BiPAP的临床应用价值。方法对80例RDS早产儿常规使用肺表面活性物质（PS）进行替代治疗后，随机分入BiPAP通气模式组（BiPAP组）和NCPAP通气模式组（NCPAP组），每组各40例。观察两组工作参数（FiO2、PEEP／EPAP），血气指标（PaO2、PaO2／FiO2、PaCO2、pH）及治疗成功率。结果①两组通气模式工作参数：FiO2、PEEP／EPAP随通气时间延长均逐渐降低，0h（上机时）两组间FiO2、PEEP／EPAP比较差异均无统计学意义（P〉0．05），上机后6、12、24、48hBiPAP组FiO2、PEEP／EPAP均明显低于对应NCPAP组（P〈0．05，P〈0．01）；②两组PaO2、PaO2／FiO2、pH均有上升趋势，PaCO2呈现降低的趋势。0h时PaO2、PaO2／FiO2、PaCO2、pH两组比较差异均无统计学意义（P〉0．05）；PaO2、PaO2／FiO2、pH在上机后6、12、24、48hBiPAP组均明显高于对应NCPAP组（P〈0．05，P〈0．01）；PaCO2于上机后6、12、24、48hBiPAP组均明显低于对应NCPAP组（P〈0．05）；③BiPAP组治疗成功率明显高于NCPAP组（P〈0．05）。结论对于RDS早产儿采用BiPAP治疗疗效优于NCPAP，具有无创、高效等优点，值得推广。

Objective To compare the blood gas and curative effects of nasal bi - level positive airway pressure（BiPAP） and nasal continuous positive airway pressure （NCPAP）in preterm infants with respiratory distress syndrome, and evaluate the clinical value of BiPAP. Methods Eighty preterm infants with respiratory distress syndrome （RDS） were randomized to BiPAP group and NCPAP with 40 cases in each group after pulmonary surfactant treatment. The ventilator parameters, blood gas and successful rate were observed in the two groups. Results （1）The ventilator parameters （ FiO2 , PEEP/ EPAP） decreased with the time of ventilation in two groups. There were no statistical differences in FiO2, PEEP/EPAP at 0 h between BiPAP group and NCPAP group（P 〉 0.05）,but the ventilator parameters （FiO2, PEEP/EPAP）were lower in BiPAP group than in NCPAP group at 6, 12,24,48 h after ventilation （ P 〈 0.05, P 〈 0.01 ） ; （2） For two groups, there were significant increases of oxygenation status（PaO2, PaOz/FiO2, pH） and decrease of PaCO2. There were no differences in PaO2, PaO2/ FiO2 , PaCO2 , pH at 0 h between two groups （ P 〉 0.05 ）, hut PaO2, PaO2/FiO2, pH were higher in BiPAP group than in NCPAP group at 6,12,24,48 h after ventilation（ P 〈 0.05 ,P 〈 0.01 ） ;while PaCO2 was lower in BiPAP group than in control group at the same time（ P 〈0.05 ） ; （3）The successful rate was higher in BiPAP group than in NCPAP group （ P 〈 0.05 ）. Conclusion For RDS treatment in preterm infants, curative effect of BiPAP is superior to NCPAP with a non - invasive and efficient advantage, should be promoted.