经鼻间歇正压通气与气管插管同步间歇正压通气治疗新生儿呼吸窘迫综合征的疗效与安全性比较

Comparison of the efficacy and safety of nasal intermittent positive pressure ventilation and tracheal intuba-tion synchronized intermittent positive pressure ventilation in treatment of neonatal respiratory distress syn-drome

目的：探讨经鼻间歇正压通气与气管插管同步间歇正压通气治疗新生儿吸窘迫综合征的疗效与安全性。方法选择60例新生儿科住院治疗的RDS且需要呼吸支持的患儿，按随机数字表法平均分为气管插管同步间歇正压通气组（ SIPPV＋VG组）和经鼻间歇正压通气组（ NIPPV组），每组30例。两组患儿均应用肺表面活性物质（ PS）替代治疗，并记录呼吸支持0 h、12 h、24 h、72 h吸入氧浓度（ FiO2）、二氧化碳分压（PaCO2）、氧分压（PaO2）、平均气道压（MAP）、血氧饱和度（SaO2），计算P/F（PaO2/FiO2）、动脉/肺泡氧分压比值（ a/APO2），并分析两组间治疗后的疗效与安全性。结果两组间0 h、12 h、24 h、72 h后MAP、FiO2和P/F（ PaO2/FiO2）差异均有统计学意义（ F＝153．247、187．385、376．587、128．509、430．276、259．507，均P＜0.05），且0 h分别与12 h、24 h、72 h的差异亦均有统计学意义（均P＜0．05）；PaO2、SaO2、a/APO2在两组间差异均有统计学意义（F＝732．756、987．835、796．37、683．508、735．375、679．509，均P＜0．05），且0 h分别与12 h、24 h、72 h的差异亦均有统计学意义（均P＜0．05）；VAP和气漏在两组间比较差异有统计学意义（ P＝0.039，0．021）。结论两种方法均能有效提高NRDS患儿氧合状态、促进气体交换功能，NIPPV法可进一步减少VAP、气漏的发生率，是临床上首选的无创机械通气方法。

Objective To investigate the efficacy and safety of nasal intermittent positive pressure ventilation and tracheal intubation synchronized intermittent positive pressure ventilation in treatment of neonatal respiratory dis-tress syndrome.Methods According to number table methods,60 children with RDS and the need for respiratory support and hospitalization were randomly divided into the intubation synchronized intermittent positive pressure venti-lation group（SIPPV＋VG group） and the nasal intermittent positive pressure ventilation group（NIPPV group）,each group 30 cases.The two groups were given pulmonary surfactant（ PS） replacement therapy,and the respiratory support 0h,12h,4h,72h fraction of inspired oxygen（FiO2）,partial pressure of carbon dioxide （PaCO2）,partial pressure of oxygen（PaO2）,mean airway pressure（MAP）,blood oxygen saturation（SaO2）,P/F（PaO2/FiO2）,arterial/alveolar oxygen partial pressure ratio（ a/APO2 ） were recorded. The efficacy and safety of the two groups after treatment were analyzed.Results The two groups of MAP,FiO2 and P/F（PaO2/FiO2） showed significant differences（F=153.247, 187.385,376.587,128.509,430.276,259.507,all P〈0.05） after 0h,12h,24h,72h and the differences between 0h and 12h,24h,72h also respectively had statistical significance（P〈0.05）;PaO2,SaO2,a/APO2 showed significant differences between the two groups （F=732.756,987.835,796.37,683.508,735.375,679.509,all P〈0.05）,and the differences of 0h and 12h,24h,72h also respectively had statistical significance（all P〈0.05）;VAP and gas leak-age had significant difference between the two groups（P=0.039,0.021）.Conclusion Both the two methods can effectively improve the oxygenation state,promote gas exchange function in children with NRDS,the NIPPV method can further reduce the incidence of VAP and gas leakage , which is clinically preferred noninvasive mechanical ventilation method.