鼻塞双水平正压通气用于呼吸窘迫综合征早产儿拔管的临床研究

A prospective randomized controlled trial of nasal bilevel positive airway pressure facilitating extubation in premature infant with RDS

目的评价鼻塞双水平正压通气(nBiPAP)作为预防新生儿呼吸窘迫综合征(RDS)撤机失败措施的临床效应。方法采用前瞻性随机对照研究方法,选择2011年1月至2012年6月收入新生儿重症监护病房且临床诊断RDS的≤32周早产儿,经气管插管及呼吸机辅助呼吸并达到撤机标准,且于初次拔管后仍有呼吸困难而需无创通气者56例作为研究对象。研究对象随机分为nBiPAP组(27例)和鼻塞持续正压通气(nCPAP)组(29例),比较两组改用无创通气前、后的血气分析、无创通气7 d内失败率及各种并发症的发生率。结果拔管后第一次的血气分析,nBiPAP组氧分压([58.7±6.3)mmHg]高于nCPAP组([55.1±5.9)mmHg],二氧化碳分压([46.4±4.9)mm Hg]低于nCPAP组([49.9±5.0)mmHg],差异均有统计学意义(P<0.05)。nBiPAP组无创通气7 d内的失败率为7.4%,低于nCPAP组的31.0%,差异有统计学意义(P=0.042)。两组并发症发生率差异无统计学意义。结论 nBiPAP作为预防胎龄≤32周合并RDS的早产儿撤机失败的效应优于nCPAP,且安全。

Objectives To assess the efficacy of nasal bilevel positive airway pressure（nBiPAP） in preventing extubation failure of neonatal respiratory distress syndrome（RDS） in premature infants.Methods Premature infants（≤32 weeks） diagnosed as RDS and treated with mechanical ventilation,admitted to the neonatal intensive care unit from January 2011 to June 2012,were enrolled in the prospective controlled trial.Fifty-six infants receiving non-invasive ventilation due to unrelieved expiratory dyspnea after the first extubation were selected,and were randomly divided into nBiPAP group（n=27） and nCPAP group（n =29）.Blood gas analysis before and after non-invasive ventilation,the failure rate of non-invasive ventilation in seven days and the incidence of various complications were compared between two groups.Results The blood gas analysis for the first time after extubation suggested that infants treated with nBiPAP had a higher PaO2 level（（58.7±6.3） vs.（55.1±5.9） mmHg,P＆lt;0.05） and lower PaCO2 level（（46.4±4.9） vs.（49.9±5.0） mmHg,P＆lt;0.05） than those treated with nCPAP.Infants treated with nBiPAP had lower incidence of extubation failure in seven days than infants treated with nCPAP（7.4% vs.31.0%,P =0.042）.The incidence of complications between two groups was similar.Conclusions nBiPAP is safe and feasible for preventing extubation failure in preterm infants ≤32 weeks with RDS and is more effective than nCPAP.