NCPAP和Bi-level NCPAP治疗早产儿呼吸窘迫综合征的疗效评价及对炎症反应的影响

The efficacy and inflammation of NCPAP and bi-level NCPAP to preterm babies with respiratory distress syndrome

目的:评价经鼻持续气道正压通气(NCPAP)和双水平NCPAP(Bi-level NCPAP)对早产儿中度呼吸窘迫综合征(RDS)的治疗效果及对炎症反应的影响。方法:42例符合标准中度RDS的早产儿,胎龄28～34周,随机分为A、B两组,分别采用NCPAP治疗(压力6 cmH2O)和Bi-level NCPAP治疗(低压4.0 cm H2O,高压7.5 cm H2O)。在出生后第1、7日检测早产儿血清细胞因子(IL-6、IL-8、TNF-α)水平,记录患儿需要呼吸支持和氧依赖的时间以及出院时的胎龄,比较两组上述指标的差异。结果:两组早产儿均存活,无支气管肺发育不良或中枢神经系统疾病的发生。出生后第1、7日B组血清IL-6、IL-8、TNF-α水平均明显低于NCPAP组(P均<0.05)。两组早产儿组内不同时间血清三种细胞因子水平比较差异无统计学意义(P均>0.05)。A组需要呼吸支持的时间、氧依赖时间均长于B组(P均<0.05)、出院时胎龄大于B组(P<0.05)。结论:与NCPAP相比,Bi-level NCPAP能更好地改善通气、缩短呼吸支持和氧依赖的时间,缩短早产儿住院时间,所引起炎症反应程度也较NCPAP低,因此Bi-level NC-PAP对早产儿具有更好的耐受性和安全性。

Objective： To evaluate the clinical efficacy and markers of inflammation in preterm infants with moderate respiratory distress syndrome （RDS） assigned from birth to nasal continuous positive airway pressure （NCPAP） or bi-level NCPAP. Methods： A total of 42 infants with a gestational age （GA） of 28-34weeka： affect- ed by moderate RDS, were considered eligible and were randomized to NCPAP n = 21, CPAP level = 6 em H20） or to bi-level NCPAP （n = 21, lower CPAP level = 4.0 cm H2O, higher CPAP level = 7.5 cm H2O） , provided with variable flow devices. Serum cytokines （ IL-6, IL-8, TNFα） were measured on days 1 and 7 of life. Length of ventilation, oxygen dependency and gestational age when discharged were noted. Results： Infants showed similar characteristics at birth. The serum cytokines （ IL-6, IL-8, TNFα） in bi-level NCPAP group were significantly low- er than those in NCPAP group, P 〈 0. 05, but these cytokines were not significantly different for different ages inthe same group, P 〉 0. 05, though the total tendency was descendent. NCPAP group underwent longer respiratory support （ P = 0. 024）, longer 02 dependencyand was discharged later （ P 〈 0. 05 ）, All infants survived. No bron- chopulmonary dysplasia （BPD） or central nervous system disorders occurred. Conclusions： Bi-level NCPAP was associated with better respiratory outcomes versus NCPAP, shorter respiratory support and O2 dependency, allowed earlier discharge. It was found to be well tolerated and safe in the study population.