经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的临床研究

Clinical study of nasal intermittent positive pressure ventilation in treatment of neonatal respiratory distress syndrome

目的探讨经鼻间歇正压通气(NIPPV)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效价值及安全性,以期更好的为临床决策与发展提供相关依据。方法通过运用前瞻性研究方法,对我院自2014年1月-2016年1月期间收治患有呼吸窘迫综合征的120例新生儿随机分组,分别采用经鼻间歇正压通气或经鼻持续气道正压通气(NCPAP)联合肺表面活性物质进行治疗,对两组患儿治疗后的临床疗效加以评价。比较指标包括:氧合指数(OI)、pH值、PaO_2、PaCO_2、治疗成功率、病死率、辅助通气时间及肺漏气率等。结果两组治疗后PaO_2、pH值、OI值均显著升高,PaCO_2显著降低(P<0.05)。治疗1 h时:间歇组PaO_2、pH值、OI值均显著高于持续组(P<0.05),两组PaCO_2差异无统计学意义(P>0.05)。治疗12 h:两组PaO_2、PaCO_2、pH值、OI值差异无统计学意义(P>0.05)。另外,NIPPV组的治疗成功率明显高于NCPAP组(P<0.05),而NCPAP组的辅助通气时间明显高于NIPPV组(P<0.05),病死率、肺气漏比较无明显统计学差异(P>0.05)。结论 NIPPV作为一种新型的无创呼吸机械通气技术,治疗效果更优,起效时间更快,治疗成功率更高,在NRDS的治疗中将有着广阔的前景,值得进行推广。

Objective To explore the clinical effect of nasal intermittent positive pressure ventilation （NIP- PV） in treatment of neonatal respiratory distress syndrome （NRDS） to better provide evidence for clinical decisions and development. Methods By forward-looking research methods, 120 newborns with respiratory distress syndrome from January 2014 to January 2016 were randomly divided into two groups, given nasal intermittent positive pressure ventilation （NIPPV） or nasal continuous positive airway pressure （NCPAP） combined pulmonary surfactant. Their clinical efficacy was compared, including oxygenation index （ OI）, pH, PaO2, PaCO2 , treatment success rate, mor- tality, assisted ventilation and pulmonary air leak rate and so on. Results After treatment, their Pa02 and OI in- creased, and pH value and PaCO2 decreased significantly （ P 〈 0. 05 ）. 1 hour after treatment, intermittent PaO2 , pH value and OI value were significantly higher than in the last group （P 〈 0. 05）, and there was no statistically signifi- cant difference in PaCO2 （ P 〉 0. 05 ）. 12 hours after treatment, there was no significant difference in PaO2 , PaCO2 and pH value and OI （P 〉 0. 05）. In addition, the successful rate was obviously higher in the NIPPV group than in the NCPAP group （ P 〈 0. 05 ）, the assisted ventilation time was significantly longer in the NCPAP group than in the NIPPV group （P 〈 0.05 ）. There was no significant difference in mortality and pulmonary air leak （ P 〉 0. 05 ）. Condusion As a new technology of non-invasive mechanical ventilation, NIPPV has the advantages of better curative effect, faster onset time and higher successful rate, which has broad prospect in the treatment of NRDS and is worthy of wide promotion.