间断并延缓撤离持续气道正压通气对早产儿呼吸支持效果的影响

The effect of intermittent and delayed withdrawal of nasal continuous positive airway pressure on respiratory support of preterm infants

目的探讨间断并延缓撤离鼻塞持续气道正压通气(nCPAP)对极低出生体重的早产儿接受氧疗时间、住院时间、支气管肺发育不良(BPD)发生率的影响。方法选取胎龄27^(+0)~31^(+6)周、出生体重<1 500 g、中-重度呼吸窘迫综合征(RDS)的早产儿92例,随机分为间断并延缓撤离组(n=47)和直接撤离组(n=45),做2年期前瞻性研究。两组均先接受气管插管机械通气联合肺表面活性物质(PS)治疗,撤离呼吸机后接受nCPAP,待病情允许分别实施间断并延缓撤离和直接撤离nCPAP。比较两组撤离nCPAP失败率、再插管率、BPD发生率,以及接受氧疗时间和住院时间。结果间断并延缓撤离组较直接撤离组撤离n CPAP失败率降低(8.5%vs.24.4%;χ~2=4.277,P<0.05),再插管率降低(4.3%vs.17.8%;χ~2=4.339,P<0.05),接受氧疗时间缩短[(19±3)d vs.(21±3)d;t=3.356,P<0.05],住院时间缩短[(42±3)d vs.(44±3)d;t=2.998,P<0.05],差异均有统计学意义;BPD发生率降低(8.5%vs.17.8%;χ~2=1.741,P>0.05),但差异无统计学意义。结论对接受nCPAP治疗的极低出生体重的早产儿采用间断并延缓撤离nCPAP失败率低,能减少再插管机会,能缩短氧疗时间及住院时间。

Objective To explore the effect of intermittent and delayed withdrawal of nasal continuous positive airway pressure（nCPAP） on very low birth weight infants. Methods A total of 92 preterm infants whose gestational age between 27^（＋ 0）~31^（＋ 6） weeks and whose birth weight less than 1 500 g with moderate or severe respiratory distress syndrome were included. Ninety-two infants were randomized to either intermittent and delayed group（n=47） or direct-off group（n=45）. All infants received mechanical ventilation and pulmonary surfactant prior to n CPAP. Either intermittent and delayed withdrawal or direct-off withdrawal was conducted when infants became stable. Withdrawals were regarded as success if infants had been withdrawn n CPAP and stable for 7 d. We regarded two withdrawals as withdrawal failure, and assessed the occurrence of reintubation, duration on oxygen, length in hospital stay and incidence of BPD by using the t test and the chi-square test. Results Primary outcomes showed that intermittent and delayed group had significantly less failure and significantly less reintubation comparing with the direct-off group（8.5% vs. 24.4%, χ2=4.277, P0.05; 4.3% vs. 17.8%,χ~2=4.339,P0.05）. Secondary outcomes showed that intermittent and delayed group had a significantly shorter oxygen duration[（19±3）d vs.（21±3）d; t = 3.356, P0.05] and a significantly shorter length in hospital stay comparing with directoff group[（42±3）d vs.（44±3）d; t = 2.998, P0.05]. Intermittent and delayed group had a insignificantly less incidence of bronchopulmonary dysplasia（BPD） comparing with the direct-off group（8.5% vs. 17.8%; χ~2=1.741, P0.05）. Conclusion The intermittent and delayed withdrawal may be associated with less failure of nCPAP, less reintubation, shorter duration on oxygen and shorter length in hospital stay for very low birth weight infants on nCPAP.