经鼻双水平正压通气治疗早产儿呼吸窘迫综合征的临床研究

Clinical study of nasal biphasic positive airway pressure ventilation in the treatment of respiratory distress syndrome of preterm infants

目的观察经鼻双水平正压通气(nBiPAP)治疗早产儿呼吸窘迫综合征(RDS)的临床效果。方法选择2016年7月~2017年2月在扬州大学医学院附属淮安妇幼保健院新生儿医学中心住院且需要无创正压辅助通气支持的78例RDS早产儿为研究对象。按照通气模式分为经鼻持续气道正压通气(nCPAP)组(n=37)和nBiPAP组(n=41),比较两组早产儿在通气0、12、24、48、72 h时的通气参数、血气分析结果、辅助通气时间、通气失败改有创通气比例、无创通气时间及并发症发生情况。结果 (1)随着通气时间的延长,两组患儿吸入氧浓度(FiO_2)及呼气末正压(PEEP)均呈逐渐下降趋势,在0 h及72 h两组比较差异无统计学意义(P>0.05),在12、24、48 h nBiPAP组参数明显低于nCPAP组,差异有统计学意义(P<0.05)。(2)随着通气时间的延长,两组患儿二氧化碳分压(PCO_2)逐渐下降,在0 h及72 h两组差异无统计学意义(P>0.05),在12、24、48 h nBiPAP组PCO2低于nCPAP组,差异有统计学意义(P<0.05)。两组动脉血氧分压/吸入氧浓度比值(P/F)及动脉/肺泡氧分压比值(PaO_2/PAO_2)随通气时间延长均呈逐渐升高趋势,在0、72 h两组差异无统计学意义(P>0.05);在12、24、48 h nBiPAP组均高于nCPAP组,差异有统计学意义(P<0.05)。(3)两组患儿通气失败改有创通气比例、无创通气时间、并发症发生率差异无统计学意义(P>0.05)。结论 nBiPAP治疗早产儿RDS有效,与nCPAP比较有一定优势。

Objective To observe the clinical effect of nasal biphasic positive airway pressure ventilation（nBiPAP） in the treatment of respiratory distress syndrome（RDS） of premature infants. Methods 78 cases of RDS preterm children who were hospitalized in Neonatal Medical Center, Huai′ an Maternal and Child Health Care Center Affiliated to Yangzhou University Medical School and treated with non-invasive positive pressure auxiliary ventilation from July2016 to February 2017 were selected. According to the ventilation mode, patients were divided into the nCPAP group（n = 37） and nBiPAP group（n = 41）. The ventilation parameters, blood gas analysis at 0, 12, 24, 48, 72 h of ventilate, auxiliary ventilation time, ventilation failure rate, noninvasive ventilation time and complications were compared between the two groups. Results（1）With the prolongation of ventilation time, the levels of inhaled oxygen（FiO2） and positive end expiratory pressure（PEEP） in the two groups gradually decreased. There were no significant differences in FiO2 and PEEP between the two groups at 0 h and 72 h（P〈0.05）, but there were significant differences between the two groups at 12,24, 48 h, the nBiPAP group were lower than the n CPAP group（P〈0.05）.（2）With the prolongation of ventilation time, the levels of PCO2 in the two groups gradually decreased. There were no significant di fferences in PCO2 between the two groups at 0 h and 72 h（P〈0.05）, but there were significant differences between the two groups at 12, 24, 48 h, the nBiPAP group were lower than the nCPAP group（P〈0.05）. With the prolongation of ventilation time, the levels of P/F and PaO2/PAO2 in the two groups gradually increased.There were no significant differences in P/F and PaO2/PAO2 between the two groups at 0 h and 72 h（P〈0.05）, but there were sign ificant differences between the two groups at 12, 24, 48 h, the nBiPAP group were higher than the nCPAP group（P〈0.05）.（3）There were no significant differences in ventilation failure rate, nonin vasive ventilation time and complications between the two groups（P〈0.05）. Conclusion nBiPAP is effective in the treatment of RDS of preterm infants, and it has certain advantages compared with nCPAP.