俯卧位持续气道正压通气治疗早产儿呼吸窘迫的临床研究

Clinical research of continuous positive airway pressure with prone position in treating premature respiratory distress

目的研究俯卧位对持续气道正压通气(CPAP)治疗早产儿呼吸窘迫的临床疗效。方法将50例需要CPAP辅助通气的中度呼吸窘迫早产儿,随机分为实验组和对照组各25例,实验组取俯卧位,对照组取仰卧位,每组患儿按治疗不同时间分为0、1、6、24h4个时段,监测各时段动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、呼吸频率(RR)、吸入氧浓度(FiO2)和氧合指数(OI)。结果与对照组相比,实验组PaCO2、FiO2、RR显著下降,差异有统计学意义(P<0.05);PaO2、OI上升更明显,差异有统计学意义(P<0.05);实验组呼吸暂停及胃潴留的发生率低,差异有统计学意义(P<0.05),而鼻塞意外脱落及鼻黏膜糜烂的发生两组比较差异无统计学意义(P>0.05)。结论 CPAP能有效治疗早产儿中度呼吸窘迫,与仰卧位相比,俯卧位更有利于氧合,并可减少呼吸暂停及胃潴留的发生率。

Objective To investigate the clinical efficacy of continuous positive airway pressure （CPAP） with the prone position for treating premature respiratory distress. Methods 50 cases of premature moderate respiratory distress needing CPAP assisted ventilation in our department from May 2011 to May 2012 were randomly divided into the experimental group（25 cases） and the control group（25 cases）; the experimental group took the prone position and the control group took the supine position. Each group was divided into the 4 time intervals of 0, 1, 6, 24h according to different treatment time, and PaO2, PaCOz, RR, FiO2 and oxygenation index（OI） at the each time interval were monitored. Results Compared with the control group, the decrease of PaCO2 ,FiO2 and RR in the experimental group had significant difference with statistical significance （P;0.05）; the increase of PaO2 and OI was more obvious, the difference showing statistical significance（P;0.05）. Compared with the control group, the occurrence rate of apnea and gastric retention in the experimental group was lower with statistical significance; but the occurrence of nasal tampon accidental drop and nasal mucosal erosion had no difference between the two groups. Conclusion CPAP is effective in treating preterm infants with moderate respiratory distress, the prone position is more conducive to oxygenation than the supine position and reduces the occurrence rate of apnea and gastric retention.