经鼻间歇与持续气道正压通气治疗新生儿呼吸窘迫综合征疗效比较

Comparison of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome

目的比较经鼻间歇正压通气(NIPPV)与经鼻持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选择2014年9月至2017年3月期间在玉林市红十字会医院新生儿科接受治疗的NRDS患儿96例,以随机数表法分为观察组(n=48)和对照组(n=48),分别给予NIPPV和NCPAP治疗,并于治疗前、治疗后1 h和12 h进行动脉血气分析,比较两组患儿氧合改善情况、呼吸机使用时间及并发症和预后等。结果治疗前,观察组患儿的氧分压(Pa O2)、二氧化碳分压(Pa CO2)水平分别为(48.7±14.1)mm Hg和(52.8±8.7)mm Hg,对照组患儿为(47.2±13.9)mm Hg和(51.1±9.2)mm Hg,两组比较差异均无统计学意义(P>0.05);治疗1 h及12 h后,两组患儿的Pa O2、Pa CO2、p H值均较治疗前明显改善,且观察组改善程度显著优于对照组,差异均有统计学意义(P<0.05);观察组患者呼吸机使用时间为(39.6±11.2)h,明显短于对照组的(52.8±10.8)h,治疗成功率为93.8%(45/48),明显高于对照组的70.1%(37/48),重新插管率为4.2%(2/48),明显低于对照组的20.1%(10/48),差异均有统计学意义(P<0.05);两组患儿并发症发生率比较差异无统计学意义(P>0.05)。结论 NIPPV较NCPAP能在较短时间内明显改善患儿肺部氧合功能,缩短呼吸机使用时间,降低气管插管呼吸机上机率。

Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation（NIPPV） and nasal continuous positive airway pressure（NCPAP） for neonatal respiratory distress syndrome（NRDS）.Methods A total of 96 cases of NRDS, who admitted to Department of Pediatrics of Hospital of Yulin Red Cross Society from September 2014 to March 2017, were selected and divided into the observation group（n=48） and the control group（n=48） according to random number table, and NIPPV and NCPAP were given respectively. The improvement of oxygenation, time of ventilator use, complications and prognosis were contrasted between the two groups. Results Before the treatment, arterial oxygen pressure（Pa O2） and arterial carbon dioxide pressure（Pa CO2） were respectively（48.7±14.1） mm Hg and（52.8±8.7） mm Hg in the observation group versus（47.2±13.9） mm Hg and（51.1±9.2） mm Hg in the control group（P〈0.05）. After the treatment of 1 h and 12 h, Pa O2, Pa CO2, and p H were significantly improved in the two groups（P〈0.05）, and the improvement of the observation group was significantly better than that in the control group（P〈0.05）. The ventilation time in observation group was（39.6±11.2） h, which was significantly shorter than（52.8±10.8） h in the control group（P〈0.05）. The success rate of treatment was 93.8%（45/48） in the observation group versus70.1%（37/48） in the control group（P〈0.05）. The rate of reintubation was 4.2%（2/48）in the observation group versus20.1%（10/48） in the control group（P〈0.05）. There was no significant difference in the incidence of complications between the two groups（P〉0.05） Conclusion Compared with NCPAP, NIPPV can improve lung oxygenation function,shorten the time of ventilator use time, and reduce the rate of endotracheal intubation in the treatment of NRDS.