经鼻间歇正压通气治疗早产儿呼吸暂停的疗效观察

Efficacy of nasal intermittent positive pressure ventilation for treatment of infants with apnea of prematurity

目的探讨经鼻间歇正压通气（NIPPV）治疗早产儿呼吸暂停（AOP）的临床疗效。方法选择2013年11月～2015年6月入住本院新生儿重症监护病房、符合入选标准的早产儿，根据随机数字表分为NIPPV组与经鼻持续气道正压通气（NCPAP）组，比较两组患儿临床疗效、上机前、上机后2h、上机后48h动脉血气、PaO2／FiO2（OI）、上机时间及并发症。结果共纳入符合标准的早产儿62例，其中NIPPV组33例，NCPAP组29例。NIPPV组和NCPAP组上机前血气pH[（7．275±0．104）vs．（7．260±0．095）]、PaO2[（50．6±11．2）vs．（46．6±11．2）mmHg]、PaCO2[（49．6±12．8）vs．（54．5±11．3）mmHg]、OI值[（213±62）vs．（188±65）]差异无统计学意义；两组上机后2h血气pH[（7．402±0．034）vs．（7．323±0．089）]、Pa02[（81．3±14．6）vs．（62．5±8．0）mmHg]、PaCO2[（38．1±5．6）vs．（44．0±9．6）mmHg]、OI值[（333±86）vs．（262±57）]及48h血气pH[（7．419±0．029）vs．（7．363±0．052）]、PaO2[（79．94±0．4）vs．（68．7±15．4）mmHg]、PaCO2[（37．1±6．1）vs．（40．2±5．6）mmHg]、OI值[（370±59）vs．（316±76）]差异均有统计学意义。NIPPV组治疗总有效率（69．7％）明显高于NCPAP组（34．5％），无创呼吸支持时间[（3．6±3．3）d]、用氧时间[（1．5±1．6）d]均短于NCPAP组[（7．8±9．4）d，（6．4±10．0）d]，两组差异均有统计学意义；两组使用氨茶碱比例（57．6％vs．55．2％）、有创呼吸支持比例（9．1％vs．3．4％）、住院时间[（34．8±20．1）d vs．（30．5±16．9）d]、支气管肺发育不良发生率（9．1％vs．17．2％）差异均无统计学意义。结论NIPPV较NCPAP治疗AOP有更好的临床疗效，可减少呼吸支持及用氧，并且不增加不良反应。

Objective To evaluate the efficacy of nasal intermittent positive pressure ventilation （NIPPV） in treating infants with apnea of prematurity （AOP）. Methods Preterm infants admitted to our neonatal intensive care unit between November 2013 and June 2015 and met the inclusion criteria were included. The subjects were randomly divided into NIPPV group and nasal continuous positive airway pressure （NCPAP） group. Arterial blood gas and PaO2/FiO2 （OI） before ventilation and 2 and 48 hours after noninvasive ventilation, the ventilation time, and complications were compared between the two groups. Results A total of 62 of infants, 33 in the NIPPV group and 29 in the NCPAP group, were included. Before ventilation, there was no statistically significant difference in pH[ （ 7. 275 ± 0. 104 ） vs. （ 7. 260 ±0.095）], PAO2[（50.6±11.2） vs. （46.6±11.2） mmHg], PACO2[（49.6±12.8） vs. （54.5 ±11.3） mmHg], and OI [ （213±62） vs. （188 ±65） ] between the two groups. However, the difference was statistically significant between the two groups inpH [（7.402±0.034） vs. （7. 323±0.089）], PaO2[（81.3±14.6） vs. （62.5±8.0） mmHg], PaCO2 [ （38. 1 ±5.6） vs. （44.0 ±9. 6） mmHg], and OI[ （333 ± 86） vs. （262 ± 57）] 2 hours after noninvasive ventilation. The difference was statistically significant between the two groups in pH [ （7. 419 ±0. 029） vs. （7. 363 ±0. 052） ], PaO2 [（79.9±10.4） vs. （68.7 ±15.4） mmHg], PaCOz[（37.1 ±6.1） vs. （40.2 ±5.6） mmHg], and OI [（370±59） vs. （316 ± 76）] 48 hours after noninvasive ventilation. The total effective rate in the NIPPV group （69.7%） was significantly higher than that in the NCPAP group （34. 5% ）. The noninvasive respiratory support time [ （3.6 ± 3.3 ）d ] and oxygen supply time [ （1.5± 1.6）d ] in the NIPPV group were shorter than those in the NCPAP group [ （7. 8 ± 9. 4）d and （6. 4 ±10. 0 ） d, respectively ] ; the difference was statistically significant. There was no statistically significant difference in the proportion of aminophylline use （57.6% vs. 55.2% ） , the proportion of the invasive respiratory support （9. 1% vs. 3.4%）, the length of hospital stay [（34.8 ±20.1）d vs. （30.5 ±16.9）d], and the incidence of bronchopulmonary dysplasia （9. 1% vs. 17. 2% ） between the two groups. Conclusion NIPPV was more efficacious than NCPAP in treating AOP, as evidenced by reduced respiratory support and oxygen without increasing side effects.