经鼻间歇正压通气与经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的随机对照研究

Nasal Intermittent Positive Pressure Ventilation and Nasal Continuous Positive Airway Pressure in the Treatment of Respiratory Distress Syndrome in Preterm: a Randomized Controlled Study

目的:比较经鼻间歇正压通气(NIPPV)与经鼻持续气道正压通气(n CPAP)对早产儿呼吸窘迫综合征(RDS)的疗效。方法:选择2013年4月至2015年3月在我院新生儿重症监护病房住院的RDS早产儿作为研究对象,按随机数字表法将研究对象随机分为NIPPV组(51例)和n CPAP组(57例),所有患儿均常规使用注射用牛肺表面活性剂(珂立苏,华润双鹤药业股份有限公司)70 mg/kg,比较两组患儿动脉血气分析结果、治疗成功率、使用NIPPV和n CPAP时间、主要并发症及其预后结局。结果:两组患儿在性别、胎龄、出生体质量、5 min Apgar评分、RDS分级、产前是否使用激素及生后使用PS情况等方面比较差异无统计学意义(P均>0.05)。NIPPV组治疗成功45例,治疗成功率88.24%,n CPAP组治疗成功41例,治疗成功率71.93%(P<0.05)。NIPPV组治疗后2 h、12 h的p H、Pa CO2、Pa O2比n CPAP组改善更明显(P<0.05)。NIPPV组与n CPAP组治疗时患儿平均使用NIPPV和n CPAP的时间比较差异无统计学意义(P>0.05)。NIPPV组呼吸暂停发生率明显低于n CPAP组,差异有统计学意义(P<0.05)。结论:NIPPV治疗早产儿RDS效果优于n CPAP。

Objective： Compare the efficacy of nasal intermittent positive pressure ventilation （NIPPV） with nasal continuous positive airway pressure （nCPAP） in premature infants during the treatment of respiratory distress syndrome （ RDS）. Methods： Premature infants who underwent RDS were selected in the department of neonatal intensive care unit （NICU） using RCT method. Each patient was treated with pulmonary surfactant （70 mg/kg ）. The study subjects were randomly divided into NIPPV group and nCPAP group, compared the two groups of patients with arterial blood gas analysis, treatment success rate, NIPPY and nCPAP time, complications and prognosis. Results： There were no significant differences in gender, age, birth weight, 5 minute Apgar score, RDS grade, the prenatal use of hormones and the use of pulmonary surfactant after birth （P 〉 0. 05 ）. In NIPPV group （51 cases ）, 45 cases were treated successfully, the success rate of treatment was 88.24%. nCPAP group （57 cases） was treated successfully in 41 cases, the success rate of treatment was 7l. 93%, the difference was statistically significant between two groups （P〈0. 05 ）. NIPPV, PaCO2, PaO2, pH were significantly improved in 2 hours and 12 hours after treatment, and the differences were statistically significant in the two groups （P〈0. 05 ）. There was no significant difference between NIPPV and NIPPV in the time of therapy （P〉0. 05 ）. The incidence of apnea in NIPPV group was significantly lower than that in nCPAP group, the difference was statistically significant （P〈0.05）. Conclusion： NIPPV in treatment of premature infants with respiratory distress syndrome is better than nCPAP.