BiPAP与nCPAP治疗新生儿呼吸衰竭的效果比较

Effect comparison between BiPAP and nCPAP on treatment of neonatal respiratory failure

目的观察双相气道正压通气(BiPAP)治疗新生儿呼吸衰竭的临床疗效。方法选取2016年盐城市妇幼保健院新生儿重症监护病房收治的新生儿呼吸衰竭患儿107例,按治疗方法不同分为观察组和对照组,观察组59例给予BiPAP治疗,对照组48例给予持续气道正压通气(nCPAP)处理。比较两组患儿的肺氧合功能、呼吸支持时间、合并症及转归。结果观察组治疗总有效率为91.53%,对照组为75.00%,两组对比有统计学差异(χ2=4.01,P<0.05)。治疗前,观察组PaO2、PaCO2、pH值、a/APO2和OI分别与对照组比较,差异均无统计学意义(均P>0.05)。治疗后同一时间点两组间比较显示,经治疗6h、24h,观察组患儿的PaO2改善优于对照组,差异均有统计学意义(t值分别为3.938、1.941,均P<0.05);经治疗6h、24h、48h,观察组在降低PaCO2方面优于对照组,差异均有统计学意义(t值分别为1.625、5.244、3.023,均P<0.05);观察组治疗后6h、24h、48h的a/APO2明显高于对照组,而OI明显低于对照组,差异均有统计学意义(a/APO2比较:t值分别为2.112、2.072、2.048,均P<0.05;OI比较:t值分别为2.262、2.387、2.362,均P<0.05)。结论 BiPAP和nCPAP均能用于改善呼吸衰竭新生儿的通气、换气功能,但BiPAP比nCPAP更加有效,可减少有创机械通气的使用,在临床上值得应用与推广。

Objective To observe the clinical efficacy of biphasic positive airway pressure (BiPAP)on the treatment of neonatal respiratory failure.Methods In 2016 totally 107 cases of neonatal respiratory failure,admitted in the Neonatal Intensive Care Unit of Yancheng Maternity and Child Health Care Hospital were selected,and they were divided into observation group and control group according to different treatment methods.The observation group with 59 cases was treated with BiPAP,and the control group with 48 cases was treated with nasal continuous positive airway pressure (nCPAP).The pulmonary oxygenation,respiratory support time,complications and prognosis were compared between two groups.Results The total efficiency of the observation group was 91.53%,and that of the control group was 75.00%.There was significant difference between two groups (x^2=4.01, P<0.05).Before treatment,there were no significant differences in PaO2,PaCO2,pH value,arterial/alveolar oxygen partial pressure (a/APO2)and oxygenation index (OI)between two groups (all P >0.05).Comparison at the same time point after treatment showed that PaO2 was better in the observation group than in the control group at 6h and 24h,and the difference was significant (t value was 3.938and 1.941,respectively,both P<0.05).Meanwhile,at 6h,24h and 48h after treatment,the observation group was superior to the control group in reducing PaCOz with statistical significance (t value was 1.625,5.244 and 3.023,respectively,all P<0.05).At 6h,24h and 48h after treatment,a/APO2was significantly higher but OI was lower in the observation group,and the differences were significant (a/APO2:t value was 2.112,2.072 and 2.048,respectively,all P<0.05;OI:t value was 2.262,2.387 and 2.362,respectively,all P<0.05).Conclusion Both BiPAP and nCPAP can be used to improve the function of ventilation and air exchange in neonates with respiratory failure,but BiPAP is more effective than nCPAP and can reduce the use of invasive mechanical ventilation.BiPAP is worthy of application and promotion in clinic.