早产极低出生体重儿鼻塞持续气道正压通气与气管插管接呼吸机通气对比分析

Effects of nasal continuous positive airway pressure and intubation in very low birth weight preterm infants with respiratory failure

目的:比较鼻塞持续气道正压通气(NCPAP)与气管插管接呼吸机通气治疗早产极低出生体重儿呼吸窘迫综合征(NRDS)的临床效果。方法:117例存在NRDS的早产极低出生体重儿随机分为观察组78例,给予NCPAP治疗;对照组39例,给予气管插管后常频机械通气(CMV)治疗,观察两组临床疗效、血气分析指标变化及并发症。结果:与对照组比较,观察组呼吸支持治疗时间、住院天数、治疗成功率及预后良好率均无统计学差异(P<0.05)。血气分析指标比较,观察组6 h后PaO2明显低于对照组(P<0.05),而治疗前及治疗后12 h、24 h各项指标均无统计学差异(P>0.05);与治疗前比较,两组治疗后6 h、12 h及24 h PaO2均显著升高(P<0.05),PaCO2显著降低(P<0.05)。观察组并发症发生率显著低于对照组(21.8%vs.28.2%,P<0.05)。结论:NCPAP与气管插管接呼吸机通气均能显著改善NRDS的早产极低出生体重儿症状,二者疗效相近,而NCPAP并发症发生率更低。

Objective： To evaluate the effects of nasal continuous positive airway pressure （NCPAP） and intubation in very low birth weight preterm infants with respiratory failure. Methods： 117 very low birth weight preterm infants with respiratory failure were random-ly assigned to NCPAP （ n = 78 ） or intubation group （ n = 39） . The clinical effects, blood gas analysis and the ratio of complication were ob-served. Results： There were no significant differences in the respiratory support therapy time, hospitalization days, achievement ratio and eu-semia rate between observe and control group （P 〉 0. 05） . PaO2 of 6 h after treatment in observe group was lower than that of control group （75.58 ±16.36） mmol/L vs. （80.58 ±18.34） mmol/L, （P〈0.05）, and the indexes of blood gas analysis in two groups before and 12 h, 24 h after treatment showed no significant difference （P 〉0. 05） . Compared with before treatment, the PaO2 in two groups at 6 h, 12 h and 24h after treatment increased significantly （P 〈 0. 05）, and PaCO2 decreased significantly （P 〈 0.05） . The complication rate of observe group was significantly lower than that of control group （21.8% vs. 28.2%, P 〈 0. 05） . Conclusion： NCPAP and ventilator intu- bated ventilation could significantly improve symptoms of very low birth weight preterm infants with NRDS, and the efficacy was similar, but the incidence of complications by NCPAP treatment is lower.