经鼻间歇正压通气与经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效比较

Efficacy comparison of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in premature infants with 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)治疗早产儿呼吸窘迫综合征(RDS)的临床效果。方法选取2016年7月至2019年6月在我院新生儿监护室治疗的轻中度RDS(Ⅰ~Ⅲ级)早产儿96例为研究对象,随机分为NIPPV组(52例)和NCPAP组(44例),分别给予NIPPV或NCPAP呼吸支持治疗,同时使用注射用牛肺表面活性剂(PS,珂立苏,70 mg/kg)进行替代治疗。比较两组患儿的基本情况、动脉血气分析结果、治疗成功率、NIPPV或NCPAP的使用时间以及主要并发症发生情况。结果两组患儿产前母亲使用激素情况、出生胎龄、性别、出生体重、1 min Apgar评分、5 min Apgar评分、RDS分级、出生后使用PS时间比较差异无统计学意义(P>0.05)。治疗2 h、6 h、12 h后,两组患儿的血pH、PaO2、PaCO2均有所改善,NIPPV组患儿的改善情况优于NCPAP组,差异有统计学意义(P<0.05)。NIPPV组患儿的治疗成功率(92.3%)显著高于NCPAP组(81.8%),使用呼吸机时间显著短于NCPAP组,差异有统计学意义(P<0.05)。NIPPV组患儿呼吸暂停、重新插管机械通气的发生率均显著低于NCPAP组,差异有统计学意义(P<0.05)。结论使用NIPPV呼吸支持治疗RDS早产儿,能更有效地改善动脉血气分析结果,提高治疗成功率,缩短呼吸机使用时间,降低并发症发生率,治疗效果优于使用NCPAP治疗。

Objective To compare the clinical effects between nasal intermittent positive pressure ventilation(NIPPV) and nasal continuous positive airway pressure(NCPAP) in premature infants with respiratory distress syndrome(RDS). Methods A total of 96 premature infants with mild to moderate RDS(Grade Ⅰ to III) treated in the neonatal unit of our hospital from July 2016 to June 2019 were selected as the research subjects, and were randomly divided into NIPPV group(52 cases) and NCPAP group(44 cases). NIPPV or NCPAP respiration supports were respectively employed to both groups;meanwhile, calf pulmonary surfactant(PS, Calsurf in 70 mg/kg) injection was performed to conduct replacement therapy. The basic conditions, arterial blood gas analysis results, treatment success rate, duration of using NIPPV or NCPAP, and the prevalence of major complications were compared between the two groups. Results There were no statistically significant differences in prenatal hormone use by mothers, gestational age, gender, birth weight, one-minute Apgar score, five-minute Apgar score, RDS grade, and PS use time after birth between the two groups(P>0.05). After 2 h, 6 h, and 12 h of treatment, the blood pH, PaO2, and PaCO2 of the children in the two groups were all improved, and the improvements of the children in the NIPPV group were superior to those in the NCPAP group. Compared to the NCPAP group, children in the NIPPV group obtained a significantly higher treatment success rate(92.3% vs. 81.8%), a shorter duration of using ventilator, and lower incidence of apnea and re-intubation mechanical ventilation, with the statistically significant differences(P<0.05). Conclusion Employing NIPPV respiratory support for treating premature infants with RDS can improve the results of arterial blood gas analysis more effectively, increase the success rate of treatment, shorten the use duration of ventilator, and decrease the incidence of complications, for the treatment effect is superior to the NCPAP treatment.