经鼻同步间歇正压通气与经鼻持续正压通气治疗早产儿合并新生儿呼吸窘迫综合征的临床疗效研究

Comparison of Nasal Synchronized Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in the Treatment of Neonatal Respiratory Distress Syndrome in Premature Infants

目的探讨早产儿合并新生儿呼吸窘迫综合征(NRDS)在"气管插管-应用肺表面活性物质-拔管"(INSURE)后使用经鼻同步间歇正压通气(NSIPPV)与经鼻持续正压通气(NCPAP)治疗的疗效及安全性。方法选择2012年1月至2013年7月于湖南省株洲市妇幼保健院新生儿科住院治疗的51例早产合并NRDS,并需进行呼吸支持患儿为研究对象。将其按照呼吸支持治疗方式,分为NSIPPV组(n=25)与NCPAP组(n=26)。分析比较两组患儿于呼吸支持治疗前及呼吸支持治疗后6h、24h、48h等时间点的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、呼吸指数(RI)、并发症及转归情况等(本研究遵循的程序符合湖南省株洲市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书)。两组患儿性别、胎龄、出生体质量等一般临床资料比较,差异无统计学意义(P>0.05)。结果本研究结果为:1两组患儿在治疗前,PaO2、PaCO2及RI比较,差异均无统计学意义(P>0.05);2PaO2水平比较:两组在治疗后6h及24h比较时,差异均无统计学意义(P>0.05),但治疗后48h时,NSIPPV组显著高于NCPAP组,且差异有统计学意义(P<0.01);两组均在治疗后6h、24h及48h时较同组治疗前显著增高,治疗后24h及48h时较同组治疗后6h时显著增高,且差异均有统计学意义(P<0.01),但治疗后24h时与同组治疗后48h时比较,差异无统计学意义(P>0.05);3PaCO2水平比较:两组在治疗后各时间点比较,差异均无统计学意义(P>0.05);两组均在治疗后6h时与同组治疗前比较及治疗后24h时与同组治疗后48h时比较,差异均无统计学意义(P>0.05),但两组均在治疗后24h、48h时较同组治疗前及治疗后24h、48h时较同组治疗后6h时显著降低,且差异均有统计学意义(P<0.01);4RI比较:NSIPPV组在治疗后6h、24h及48h时均显著低于NCPAP组,且差异有统计学意义(P<0.01);两组治疗后每个时间点分别与同组前面比较,差异均有统计学意义(P<0.01);5两组再插管率及腹胀发生率比较,差异均无统计学意义(P>0.05),但NSIPPV组经鼻通气时间显著少于NCPAP组,且差异有统计学意义(P<0.05),两组均无一例患儿发生支气管肺发育不良(BPD)、颅内出血及气漏。结论 NSIPPV及NCPAP 2种无创通气模式对治疗NRDS均有较好疗效,能显著改善肺部氧合功能,且二氧化碳储留均不明显;2种模式安全性均较好;NSIPPV较NCPAP更有效,经鼻通气时间更短,改善肺的通气及氧交换能力更强。

Objective To investigate efficacy and safety of nasal synchronized intermittent positive pressure ventilation （NSIPPV）and nasal continuous positive airway pressure （NCPAP）after INSURE procedure in the treatment of neonatal respiratory distress syndrome （NRDS ） in premature infants. Methods A total of 5 1 premature infants who were diagnosed as NRDS and required respiratory support hospitalization and treatment in neonatal department of Zhuzhou Maternal and Child Health Care Hospital of Hunan Province from January 2012 to July 2013 were chosen as study subjects.They were randomly assigned to NSIPPV group （n=25）and NCPAP group （n=26）in accordance with the respiratory support＆amp;nbsp;mode.The arterial oxygen pressure（PaO2 ）,arterial carbon dioxide tension（PaCO2 ）,respiratory index（RI）, complications and outcomes before respiratory support and 6 h,24 h,48 h after respiratory support between two groups were analyzed and compared.The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Zhuzhou Maternal and Child Health Care Hospital.Informed consent was obtained from the parents of each participating patient.The general clinical data such as gender,gestational age and birth weight between two groups had no statistically significant difference（P〉0.05）.Results The results of this study followed as：①The PaO2 ,PaCO2 and RI levels prior treatment between two groups had no statistically significant difference（P〉0.05）.②Comparison of PaO2 level：There were no statistically significant difference between two groups 6 h and 24 h post-treatment（P〉0.05）,but the PaO2 level of NSIPPV group was statistically higher than that of NCPAP group 48 h post-treatment（P〈0.01）;The PaO2 level in the two groups both were statistically higher compared 6 h,24 h,48 h post-treatment to prior treatment and compared 24 h,48 h post-treatment to 6 h post-treatment in the same group（P〈0.01）,but compared 24 h post-treatment to 48 h post-treatment in the same group had no statistically significant difference（P〉0.05）.③Comparison of PaCO2 level：There were no statistically significant difference between two groups in three time points post-treatment（P〉0.05）;The PaCO2 level in the two groups both had no significant difference compared 6 h post-treatment to prior treatment and compared 24 h post-treatment to 48 h post-treatment in the same group （P〉0.05 ）,but the PaCO2 level in the two groups both were statistically lower compared 24 h,48 h post-treatment to prior treatment and compared 24 h,48 h post-treatment to 6 h post-treatment in the same group（P〈0.01）.④Comparison of RI level：The RI level of NSIPPV group was statistically lower than that of NCPAP group at 6 h,24 h,48 h post-treatment（P〈0.01）;The RI level in the two groups both were statistically lower compared each time point after treatment to any prior time point in the same group （P〈0.01）.⑤The reintubation rate and abdominal distension incidence between two groups had no statistically significant difference（P〉0.05）,but nasal ventilation time of NSIPPV group was statistically less than NCPAP group （P〈0.05 ）.Both groups had no bronchial pulmonary dysplasia（BPD）,intracranial hemorrhage and gas leakage.Conclusions NSIPPV and NCPAP two kinds of noninvasive ventilation mode for treatment of NRDS had a good effect,which can significantly improve lung oxygenation function.Carbon dioxide retention was not obvious.Both modes had better safety.NSIPPV was more efficient than NCPAP for treatment of NRDS,nasal ventilation time was shorter and the capacity to improve pulmonary ventilation and oxygen exchange was greater.