不同经鼻正压通气方式在早产儿呼吸暂停中的应用

Different modes of nasal positive airway pressure in preterm infants with apnea

目的比较经鼻Duopap正压通气和经鼻持续正压通气(nCPAP)在早产儿呼吸暂停中的应用效果。方法选择本科2007年11月至2011年11月收治的存在呼吸暂停的早产儿86例,常规方法治疗的同时,随机分入Duopap组和nCPAP组,每组各43例。观察两组的临床疗效。结果①两组患儿辅助通气参数FiO2、PEEP随通气时间延长,均逐渐降低。开始应用辅助通气时(0h)两组患儿FiO2、PEEP比较差异无统计学意义(P>0.05);24h、48h Duopap组FiO2、PEEP均低于nCPAP组,差异有统计学意义(P<0.05)。②两组患儿PH值、PaO2、PaCO2随治疗时间延长逐渐恢复正常。0h两组患儿PH值、PaO2、PaCO2比较差异无统计学意义(P>0.05)。上机24小时,Duopap组的血气分析指标明显好于nCPAP组,差异有统计学意义(P<0.05)。上机48小时两组指标比较差异无统计学意义(P>0.05)。③Duopap组通气时间明显短于nCPAP组,治疗成功率高于nCPAP组。两组气胸发生率差异无统计学意义(P>0.05)。结论 Duopap通气治疗早产儿呼吸暂停的疗效优于nCPAP,其具有安全、高效、简便等优点,值得在临床工作中推广应用。

Objective To compare the therapeutic effects of nasal Duopap positive airway pressure （Duopap） and nasal continuous positive airway pressure（nCPAP） for apnea in preterm infants. Methods Eighty - six preterm infants with ap- nea treated in our department form November 2007 to November 2011 were selected and randomized to Duopap group and nCPAP group, with 43 cases in each group. Clinical efficacy was observed in both groups. Results （ 1 ） Parameters of mechanical ventilation, such as FiO2 and PEEP decreased gradually with ventilation in both groups. FiO2 and PEEP showed no statistically significant difference at the initiation of ventilation （Oh） （P 〉 0.05 ） ,but they were lower in Duopap group than in nCPAP group 24h ,48h after ventilation（ P 〈 0.05 ）. （2）For two groups, the results of blood gas a- nalysis （ PH, PaO2, PaCO2） returned to normal with the application of ventilation. PH, PaO2 and PaCO2 showed no sta- tistically significant difference at the initiation of ventilation （0h） and 48h after ventilation （ P 〉 0.05 ）, but they were bet- ter in Duopap group than in nCPAP group 24h after ventilation（ P 〈 0.05 ）. （3） Duopap group had a significantly shorter duration of ventilation and a higher treatment success rate than nCPAP group. No significant difference was found in the in- cidence of pneumothorax （ P 〉 0.05 ）. Conclusions Nasal Duopap is superior to nCPAP in treating preterm infants with apnea. It is of safety, high efficiency and simple application, which is worthy of clinical promotion.