鼻塞式双相气道正压通气与鼻塞式持续气道正压通气治疗新生儿呼吸窘迫综合征疗效比较

Clinical Analysis of Neonatal Respiratory Distress Syndrome with Nasal-Type Bilevel Positive Airway Pressure and Nasal-Type Continuous Positive Airway Pressure

目的:比较鼻塞式双相气道正压通气(N-Bi PAP)和鼻塞式持续气道正压通气(n CPAP)治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效及安全性。方法:选择我院2016年3月至9月收治住院的51例NRDS患儿随机分为观察组和对照组。观察组给予N-Bi PAP,对照组给予n CPAP治疗。两组患儿治疗前(Ta)、治疗后2 h(Tb)、12 h(Tc)、36 h(Td)进行动脉血气分析,比较两组患儿吸入氧浓度(FiO_2)、pH、血氧分压(PaO_2)及二氧化碳分压(Pa CO2)指标情况;比较两组患儿气管插管机械通气率、总通气时间、氧疗时间、支气管肺发育不良(BPD)发生率、脑室内出血(IVH)发生率、坏死性小肠结肠炎(NEC)发生率及病死率。结果:两组患儿Ta时Pa CO2、PaO_2、pH比较差异无统计学意义(P>0.05)。观察组患儿治疗后Tb、Tc、Td时间点pH、PaO_2高于对照组,Tb、Tc、Td时间点的Pa CO2、FiO_2低于对照组,但Tb时间点比较差异均无统计学意义(P>0.05),Tc、Td时间点比较差异有统计学意义(P<0.05)。观察组总通气时间、氧疗时间短于对照组,气管插管机械通气率、BPD发生率、IVH发生率及NEC发生率低于对照组,但总通气时间及氧疗时间比较差异有统计学意义(P<0.05),气管插管机械通气率、BPD发生率、IVH发生率及NEC发生率比较差异无统计学意义(P>0.05)。两组均无死亡病例。结论:N-Bi PAP治疗NRDS较n CPAP可更有效地缓解临床症状及缩短用氧时间,减少有创机械通气率,且安全性优于n CPAP。

Objective： To investigate the effects of nasal-type bilevel positive airway pressure （N-BiPAP） and nasal-type continuous positive airway pressure （nCPAP） in the treatment of neonatal respiration distress syndrome （NRDS）. Methods： Choosing the children from March to September 2016 were admitted during the period of 51 cases of NRDS randomly divided into observation group and control group. The observation group was treated with N-BiPAP, and the control group was treated with nCPAP. Analyzed the arterial blood gas of the two groups before treatment （ T ） and after treatment for 2 h （ TL ） , 12 h （ T~ ） , 36 h （ TO ）, compared the oxygen density （ FiO2 ）, pH, l？aO2 and PaCO2. The trachea cannula mechanical ventilation rate, total ventilation time, oxygen therapy time, incidence of BPD, YV＇YI and NEE, death rate were compared between two groups. Results： There were no statistically significant differences between two groups of PaO2, PaCO2 and pH in To（P〉0. 05）. pH, PaO2 of observation group were higher than control group, PaCO2, FiOz were lower than control group in Tb, T, Td, but there were no statistically significant differences in Tb（ P〉0. 05 ）, and there were statistically significant differences in T~, Ta（P〈0.05 ）. The total ventilation time, oxygen therapy time, trachea cannula mechanical ventilation rate and the incidence of BPD, IVH, NEC were lower than those of control group, but differences of the total ventilation and oxygen therapy time were statistically significant （ P〈0. 05 ）, the trachea cannula mechanical ventilation rate and the incidence of BPD, IVH, NEC had no statistically significant differences （P〉0. 05 ）. There was no death in two groups. Conclusion： N-BiPAP in the treatment of NRDS can more effectively relieve clinical symptoms and shorten the time with oxygen, reduce the rate of invasive mechanical ventilation, and security is better than nCPAP.