双水平正压通气和经鼻持续呼吸道正压通气在早产儿呼吸窘迫综合征撤机后应用的比较

Duo positive airway pressure ventilation versus nasal continuous positive airway pressure in treatment of preterm neonates with severe neonatal respiratory distress syndrome after extubation

目的 比较患有重度新生儿呼吸窘迫综合征（NRDS）的早产儿撤机后使用双水平正压通气（DuoPAP）和持续呼吸道正压通气（nCPAP）的效果,确定DuoPAP是否可降低撤机失败率.方法 该试验为单中心随机对照试验,将胎龄29～34^6/7周患有重度NRDS需要有创呼吸,并且在出生后4周内撤机的早产儿随机分为DuoPAP组和nCPAP组,若2种方式不能维持则再次使用气管内插管、呼吸机辅助呼吸.撤机后72 h内需要再次插管上机为撤机失败.主要观察指标为撤机失败率及撤机失败原因.结果 DuoPAP组撤机失败率为11.43％（4/35例）,明显低于nCPAP组（35.29％,12/34例）（P=0.02）.2组总用氧时间、有创呼吸支持时间、气胸发病率、坏死性小肠结肠炎发病率、脑室内出血发病率（Ⅲ度以上）、全肠道喂养时间、总住院时间、恢复出生体质量时间、体质量增长率比较差异均无统计学意义.结论 与nCPAP相比,撤机后使用DuoPAP可明显降低重度NRDS患儿撤机失败率.

Objective To determine whether duo positive airway pressure （DuoPAP） can decrease the rate of extubation failure in preterm neonates with severe neonatal respiratory distress syndrome （NRDS）,in comparison to nasal continuous positive airway pressure （nCPAP）.Methods In this single-center,randomized controlled trial,infants （gestational ages 29-34^6/7 weeks） with NRDS who needed endotracheal intubation and met specific predetermined criteria for extubation by day within 4 weeks of birth were enrolled.Each infant was randomized to receive either DuoPAP or nCPAP soon after extubation.Extubation was deemed successful if reintubation was not needed for at least 72 h.If the 2 noninvasive ventilations were not effective,intubation and mechanical ventilation （MV） were used.The primary outcome was the rate of extubation failure and its causes within the first 72 hours of extubation.Results In this study,11.43 %（4/35 cases） infants were failed to be extubated in DuoPAP group,but 35.29% （12/34 cases） in nCPAP group,and there was significant difference between the 2 groups （P =0.02）.No significant differences were noted between the 2 groups in total time of oxygen,total time on MV,pneumothorax,necrotising enterocolitis,intraventricular hemorrhage （grades Ⅲ and Ⅳ）,retinopathy of prematurity,time to full feeds,recovery time of the birth weight,weight increasing rate and duration of hospitalization.Conclusion DuoPAP can decrease the rate of extubation failure in severe NRDS compared with nCPAP.