双水平正压通气治疗极低出生体重早产儿呼吸窘迫综合征应用价值

Application value of Duo positive pressure ventilation in the treatment of very low birth weight preterm infants with respiratory distress syndrome

目的探讨鼻塞式双水平正压通气(DuoPAP)在治疗极低出生体重早产儿呼吸窘迫综合征(NRDS)临床应用效果。方法 2013年1月至2014年2月徐州市中心医院新生儿重症监护病房(NICU)收治85例极低出生体重NRDS患儿,随机将患儿分为nDuoPAP组45例,鼻塞式持续气道正压通气(nCPAP)组40例,主要观察两组使用无创呼吸支持后1 h、12 h、24 h的pH值、二氧化碳分压(PaCO2)、血氧分压(PaO2)、氧合指数(OI=PaO2/FiO2)、失败例数等。结果 nDuoPAP组无创辅助通气1 h、12 h、24 h评估PaCO2、PaO2、OI与nCPAP组比较有明显改善,差异均有统计学意义(P<0.05);nDuoPAP组与nCPAP组上机失败率(4.44%vs.22.50%)以及呼吸暂停发生率(13.33%vs.32.50%),差异均有统计学意义(P<0.05);nDuoPAP组与nCPAP组无创通气时间[(3.61±0.97)d vs.(3.44±1.18)d],发生气漏综合征、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)、脑室内出血(IVH)及脑室周围白质软化(PVL)例数,差异均无统计学意义(P>0.05)。结论 nDuoPAP治疗NRDS,与nCPAP相比更能改善氧合,减少CO2潴留,减少有创机械通气比例及并发症。

Objective To investigate the clinical application effect of nasal Duo positive airway pressure （DuoPAP） in the treatment of very low birth weight preterm infants with respiratory distress syndrome （NRDS）.Methods 85 cases of very low birth weight preterm infants with NRDS from Xuzhou central hospital neonatal intensive care unit（NICU） from 2013 January to 2014 February were randomly divided into two group, nDuoPAP group 45 cases, nasal continuous positive airway pressure （nCPAP） group 40 cases, the main observation was the comparison of pH value, partial pressure of carbon dioxide （PaCO2）, partial pressure of oxygen （PaO2）, oxygenation index （OI= PaO2/FiO2）, failure cases in two group after 1 h, 12 h, 24 h.Results PaCO2, PaO2, OI （PaO2/FiO2）, the number of failure cases and the incidence of apnea at 1 h, 12 h, 24 h during using DuoPAP, DuoPAP were improved significantly in nDuoPAP group compared with nCPAP group（P〈0.05）. There was no statistical significance between both groups in the noninvasive ventilation time, （3.61±0.97）dvs. （3.44±1.18）d and gas leak syndrome and bronchopulmonary dysplasia（BPD） and retinopathy of premature children （ROP） and intraventricular hemorrhage（IVH） and periventricular leukomalacia（PVL）.ConclusionnDuoPAP could improve oxygenation and reduce CO2 retention, reduce the proportion of invasive mechanical ventilation and complications.