间歇与持续经鼻气道正压通气治疗早产儿反复呼吸暂停的临床分析

Clinical analysis of intermittent and continuous nasal positive airway pressure treatment on recurrent apnea in preterm children

目的 比较经鼻间歇正压通气（NIPPV）与经鼻持续气道正压通气（NCPAP）治疗早产儿原发性呼吸暂停（AOP）的疗效,为AOP的治疗提供科学依据.方法 选择76例AOP患儿,按随机数字表法分为NIPPV组（40例）和NCPAP组（36例）.比较两组血气变化、治疗的疗效、两组治疗后需有创机械通气的比率（即为治疗无效率）、辅助通气时间、并发症发生情况及预后.结果 两组治疗前的血气分析比较差异无统计学意义（P＞0.05）,治疗后1,12h血气分析比较差异有统计学意义（P＜ 0.05）.NIPPV组治愈率、有效率、无效率均明显优于NCPAP组,辅助通气时间明显短于NCPAP组,差异有统计学意义（P＜0.05）.NIPPV组治愈率、有效率、无效率均明显优于NCPAP组[82.5％（33/40）比61.1％（22/36）、92.5％（37/40）比80.6％（29/36）、7.5％（3/40）比19.4％（7/36）],辅助通气时间明显短于NCPAP组[（39.45±6.99）h比（69.39±20.51）h],差异有统计学意义（P＜0.05）.两组脑室内出血、支气管肺发育不良、新生儿坏死性小肠结肠炎发生率比较差异无统计学意义（P＞0.05）.NIPPV组早产儿视网膜病、脑室周围脑白质软化发生率明显低于NCPAP组[2.5％（1/40）比13.9％（5/36）、2.5％（1/40）比11.1％（4/36）],差异有统计学意义（P＜0.05）.结论 NIPPV治疗早产儿反复呼吸暂停疗效及预后优于NCPAP.

Objective To compare nasal intermittent positive pressure ventilation （NIPPV） with nasal continuous positive airway pressure （NCPAP） treatment of primary apenea of premature （AOP） effect,and provide a scientific basis for the AOP treatment.Methods Seventy-six cases of children with AOP were randomly divided into NIPPV group （40 cases） and NCPAP group （36 cases）.Comparison of two groups changes of blood gas,curative effect,after treatment for invasive mechanical ventilation ratio,ventilation time,and so on.Results Blood gas analysis of two groups before treatment had no significant difference （P 〉 0.05）,1,12 h after treatment of blood gas analysis was statistically significant （P 〈 0.05）.The cure rate,effective rate and inefficiency in NIPPV group were significantly better than those in NCPAP group [82.5% （33/40）vs.61.1% （22/36）,92.5% （37/40） vs.80.6% （29/36）,7.5% （3/40） vs.19.4% （7/36）].Assisted ventilation time was significantly shorter in NCPAP group[（39.45 ± 6.99） h vs.（69.39 ± 20.51） h].The difference was statistically significant （P 〈 0.05）.Two groups of intraventricular hemorrhage,bronchial pulmonary hypoplasia,neonatal necrotizing enterocolitis incidence rate had no significant difference （P 〉0.05）.In NIPPV group the incidence rate of premature infant retina disease and cererbral white matter softening around the ventricle was significantly lower than that in NCPAP group [2.5% （1/40） vs.13.9%（5/36）,2.5%（1/40） vs.11.1%（4/36）].The difference was statistically significant （P 〈 0.05）.Conclusion NIPPV in the treatment of recurrent apnea in premature infants curative effect and prognosis is better than NCPAP.