经鼻持续气道内正压在新生儿呼吸窘迫综合征机械通气撤离后应用的临床探讨

The clinical investigation of application of nasal continuous positive airway pressure in neonatal respiratory distress syndrome after weaning from mechanical ventilation

目的 探讨经鼻持续气道内正压（NCPAP）在新生儿呼吸窘迫综合征（NRDS）机械通气撤离后应用的有效性及临床价值.方法 将接受机械通气的92例NRDS患儿按机械抽样法随机分为NCPAP组（46例）和头罩给氧组（46例）,比较两组的撤机成功率以及各种并发症如呼吸暂停、支气管肺发育不良、呼吸机相关性肺炎、脑室内出血、脑室周围白质软化、早产儿视网膜病的发生率.结果 NCPAP组41例一次撤机成功,成功率89.13％（41/46）,头罩给氧组33例一次撤机成功,成功率71.74％（33/46）,两组比较差异有统计学意义（P＜0.05）.NCPAP组呼吸暂停、支气管肺发育不良的发生率均低于头罩给氧组[15.22％（7/46）比36.96％ （17/46）、6.52％（3/46）比21.74％（10/46）],两组比较差异有统计学意义（P＜0.05）；两组呼吸机相关性肺炎、脑室内出血、脑室周围白质软化、早产儿视网膜病的发生率比较差异无统计学意义（P＞0.05）.结论 NRDS患儿撤机过程中用NCPAP进行过渡比头罩给氧直接脱机更有效,值得在临床实践中进一步研究和推广应用.

Objective To investigate the validity and clinical value of application of nasal continuous positive airway pressure （NCPAP） in neonatal respiratory distress syndrome （NRDS） after weaning from mechanical ventilation.Methods The 92 infants with NRDS received mechanical ventilation were randomly divided into the group of NCPAP （46 cases） and the group of oxygen via head box （46 cases） by systematic sampling method.The successful rate of weaning from mechanical ventilation,and incidence of complications such as apnea,broncho-pulmonary dysplasia,ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infant were compared between the 2 groups.Results The group of NCPAP,41 cases were successful of weaning from mechanical ventilation,the successful rate was 89.13% （41/46）.The group of oxygen via head box,33 cases were successful of weaning from mechanical ventilation,the successful rate was 71.74%（33/46）.There was statistical difference between the 2 groups （P 〈0.05）.The incidences of apnea and broncho-pulmonary dysplasia in the group of NCPAP were significantly lower than those in the group of oxygen via head box [15.22% （7/46） vs.36.96% （17/46）,6.52% （3/46） vs.21.74% （10/46）],there were statistical differences between the 2 groups （P 〈 0.05）.There were no statistical differences in the incidences of ventilator-associated pneumonia,intraventricular hemorrhage,periventricular leukomalacia,retinopathy of premature infants between the 2 groups （P 〉 0.05）.Conclusion NCPAP is more effective than directly removing respirator in the infants with NRDS weaning from mechanical ventilation,it deserves further study and application in clinical practice.