双水平正压通气与持续呼吸道正压通气在早产儿呼吸窘迫综合征中的比较研究

Comparison of Bi-level positive airway pressure and continuous positive airway pressure in preterm infants with respiratory distress syndrome

目的：比较双水平正压通气（Bi PAP）和持续呼吸道正压通气（NCPAP）联合肺表面活性物质（PS）在早产儿呼吸窘迫综合征（RDS）中的应用效果,探讨是否可以降低气管插管有创呼吸支持率。方法：将胎龄在28~34周（＋6 d）的RDS早产儿随机分为Bi PAP组（24例）和NCPAP组（25例）,常规使用PS进行替代治疗,若这两种方式不能维持患儿生命体征则使用气管内插管,接呼吸机辅助呼吸。主要观察指标为出生24 h、48 h及72 h插管有创呼吸支持率,次要观察指标为气胸发病率、坏死性小肠结肠炎发病率、脑室内出血发病率（Ⅲ级以上）。结果：两组早产儿出生24 h总插管有创呼吸支持率比较无差异;Bi PAP组48 h、72 h插管有创呼吸支持率明显低于NCPAP组,差异有统计学意义（x2=4.056,x2=4.325;P〈0.05）。两组间次要观察指标比较差异均无统计学意义。结论：早期使用Bi PAP可明显降低RDS患儿出生24 h后总插管有创呼吸支持率。

Objective：To compare the therapeutic effects for nasal bi-level positive airway pressure （BiPAP） and nasal continuous positive airway pressure （NCPAP） combined with pulmonary surfactant in preterm infants with respiratory distress syndrome （RDS） and to determine whether can reduce the need for intubation and mechanical ventilation.Methods： In this single-center, randomized controlled trial, preterm infants （gestational ages were 28-34＋6weeks） with RDS were randomly assigned to BiPAP group （24 cases） and NCPAP group（25 cases）. If the 2 noninvasive ventilation were not effective, intubation was administered as rescue therapy. The primary outcome was the need for mechanical ventilation within the first 24 hours, 48 hours, 78 hours of life. The secondary outcomes were incidence of pneumothorax, incidence of necrotizing enterocolitis, incidence of intraventricular hemorrhage（grade 3 and grade 4）.Results： Rates of intubation in the first 24 hours did not differ significantly between the BiPAP group and NCPAP group, however, significantly more infants in the BiPAP group remained extubated compared with those in the NCPAP group within 48 hours, 72 hours （x2=4.056,x2=4.325;P＆lt;0.05）. No significant differences were noted between the 2 treatment groups for the secondary outcomes.Conclusion： BiPAP can decrease the need for mechanical ventilation compared with NCPAP after 24 hours.