鼻塞式双水平无创正压通气在极低出生体质量患儿呼吸支持中的应用价值

Application value of nasal intermittent positive pressure ventilation on respiratory support in children with very low birth weight

目的：探讨鼻塞式双水平无创正压通气（NIPPV）在极低出生体质量患儿（VLBW）呼吸支持中的应用价值。方法将2013年1月至2015年12月靖江市人民医院出生的极低出生体质量患儿58例作为研究对象，按照随机数字表法分为对照组和观察组，每组29例，对照组患儿给予鼻塞式持续正压通气，观察组患儿给予鼻塞式双水平无创正压通气，观察两组患儿的 CO2潴留、改善氧合、气管插管率和再次使用肺表面活性物质率、有创呼吸支持时间、需氧时间，以及并发症发生情况。结果呼吸支持12 h 后观察组患儿PaCO2（46．71±5．22）、（43．16±3．94）、（41．16±3．92）mmHg，低于对照组的（50．27±4．17）、（48．71±3．86）、（45．74±3．85）mmHg；氧合指数（226．71±28．61）、（241．53±24．37）、（258．14±23．78）mmHg，高于对照组的（209．15±27．85）、（221．27±28．65）、（226．71±27．91）mmHg，差异均有统计学意义（t ＝2．869、5．419、4．489、2．368、2．901、4．616，均 P ＜0．05）。观察组再次气管插管率13．79％、再次使用肺表面活性物质率10．34％、有创呼吸支持时间（35．41±11．26）h 和需氧时间（19．48±9．37）h，低于对照组的44．83％，41．38％，（62．17±13．51），（35．43±10．27），差异均有统计学意义（χ2＝6．740、7．284，t ＝8．194、6．178，均 P ＜0．05）。两组并发症主要为气漏、坏死性小肠结肠炎、早产儿视网膜病及脑室内出血等，并发症发生率差异无统计学意义（P ＞0．05）。结论NIPPV 应用于极低出生体质量患儿呼吸支持可改善 CO2潴留和氧合，减少气管插管和再次使用肺表面活性物质，降低呼吸支持和需氧时间，临床有效、安全，值得推广。

Objective To study the application value of nasal intermittent positive pressure ventilation（NIPPV） on respiratory support in children with very low birth weight.Methods 58 children with very low birth weight were divided into control group and observation group according to random number table method from January 2013 to December 2015 in our hospital,29 cases in each group.The control group was given nasal continuous positive airway pressure,and the observation group was given NIPPV.The CO2 retention,improve oxygenation,the rate of endotracheal intubation,once again use lung surface active substance,respiratory support time,aerobic time and complications were observed.Results After 12h respiratory support,the PaCO2 of the observation group [（46.71 ±5.22）mmHg, （43.16 ±3.94）mmHg,（41.16 ±3.92）mmHg]were lower than those of the control group[（50.27 ±4.17）mmHg, （48.71 ±3.86）mmHg,（45.74 ±3.85）mmHg],the oxygenation index of the observation group[（226.71 ±28.61）mmHg, （241.53 ±24.37）mmHg,（258.14 ±23.78）mmHg]were higher than those of the control group[（209.15 ±27.85）mmHg, （221.27 ±28.65）mmHg,（226.71 ±27.91）mmHg],the differences were statistically significant（t =2.869,5.419, 4.489,2.368,2.901,4.616,all P 〈0.05 ）.The endotracheal reintubation rate,again using lung surface active substance rate,respiratory support time and aerobic time in the observation group were 13.79%,10.34%,（35.41 ± 11.26）h,（19.48 ±9.37）h,which were lower than those in the control group[44.83%,41.38%,（62.17 ±13.51）h, （35.43 ±10.27）h],the differences were statistically significant （χ2 =6.740,7.284,t =8.194,6.178,all P 〈0.05）.The main complications were gas leakage,necrotizing enterocolitis,premature retinopathy and intraventricular hemorrhage.The incidence rate of complication had no statistically significant difference （P 〉0.05 ）.Conclusion NIPPV applied in very low birth weight in children with respiratory support can improve the CO2 retention and oxygenation, reduce endotracheal reintubation and again using lung surface active substances,reduce respiratory support and aerobic time.The clinical effect is effective and safe,which is worthy of promoting.