鼻塞式双水平正压通气在早产儿肺透明膜病撤机的临床应用

Application value of nasal Duo positive airway pressure ventilation in the treatment of hyaline mem-brane disease of preterm infants

目的：探讨鼻塞式双水平正压通气（ nasal Duo positive airway pressure ventilation, nDuoPAP）在早产儿肺透明膜病（ hyaline membrane disease,HMD）呼吸机撤离中的临床应用。方法收集2013年1月至2014年6月徐州市中心医院NICU收治76例HMD（Ⅲ~Ⅳ级）机械通气早产儿,采用随机数字表法将患儿随机分为nDuoPAP组41例,鼻塞持续气道正压通气（ nasal continuous positive air-way pressure,nCPAP）组35例,观察患儿撤机后pH值、PaCO2、PaO2、氧合指数以及撤机效果。结果nDuoPAP组撤机后1 h、24 h, PaCO2、PaO2、氧合指数与 nCPAP 组比较,差异均有统计学意义（ P 〈0．05）。 nDuoPAP组与nCPAP组撤机失败率[5%（2/41） vs．26%（9/35）]以及呼吸暂停发生率[12%（5/41） vs．34%（12/35）]比较,差异均有统计学意义（P〈0．05）；nDuoPAP组与nCPAP组无创通气时间[（2．88±1．37） d vs．（3．12±1．09） d]比较,差异无统计学意义（P〉0．05）。结论 nDuoPAP用于HMD呼吸机的撤离,与nCPAP相比,可改善氧合,缓解二氧化碳潴留和减少呼吸暂停的发生。

Objective To investigate the clinical application of nasal Duo positive airway pressure ventilation（ nDuoPAP） in the treatment of ventilator withdrawal on hyaline membrane disease of preterm infants. Methods The total of 76 cases of preterm infants with hyaline membrane disease in NICU of Xuzhou Central Hospital from January 2013 to June 2014 were divided into two groups by random number table method：nDuoPAP group（41 cases） and nasal continuous positive airway pressure（nCPAP） group（35 cases）. The main observation consequences were compared with the pH value,PaCO2 ,PaO2 ,oxygenation index（ OI） and the effect of weaning. Results The PaCO2 , PaO2 , OI at 1 h and 24 h after weaning between the two groups showed significant difference（P〈0. 05）. The weaning failure rate[5%（2/41） vs. 26%（9/35）] and the apnea rate[12%（5/41） vs. 34%（12/35）] between the two groups were significant difference（P 〈0. 05）. The noninvasive ventilation time between the two groups showed no significant difference （ P〉0. 05 ） . Conclusion nDuoPAP compared with nCPAP used in the weaning of mechanical ventilation can improve the oxygenation index and relieve carbon dioxide retention,and can reduce the incidence of apnea in preterm infants with hyaline membrane disease.