早产儿使用肺表面活性物质拔管后应用不同通气模式呼吸支持的效果研究

Study on the effects of different ventilation modes on respiratory support for premature infants after extubation by pulmonary surfactant

目的分析不同通气模式在早产儿使用肺表面活性物质(PS)拔管后呼吸支持中的临床效果,为新生儿呼吸窘迫综合征(NRDS)患儿通气模式的选择提供参考依据。方法选取2017年3月—2019年3月期间广西壮族自治区妇幼保健院收治的早产患儿80例随机分为观察组和对照组,各40例。均给予气管插管-应用PS-拔出气管插管治疗。观察组给予同步鼻塞间歇正压通气(SNIPPV)呼吸支持,对照组给予经鼻持续气道正压通气(NCPAP)支持,比较两组患儿治疗期间血气指标、临床指标、有创呼吸支持率及并发症情况。结果观察组患儿通气1、12 h和24 h的二氧化碳分压(PaCO2)、氧合指数(OI)均低于对照组,通气1 h、12 h的氧分压(PaO2)高于对照组,差异有统计学意义(P<0.05);观察组治疗期间内有创呼吸支持率(20.00%)、并发症发生率(22.50%)低于对照组(52.50%、47.50%)(χ2=9.141、5.495,P<0.05);观察组患儿的有创通气时间、氧疗时间、住院时间均小于对照组,差异有统计学意义(t=5.821、41.681、3.924,P<0.05)。结论与NCPAP相比,SNIPPV能够更有效地改善NRDS患儿的氧合情况,降低CO2潴留,缩短通气支持时间、开奶时间、住院时间,还可以降低并发症的发生率。

Objective To compare clinical effects of different ventilation modes on respiratory support for premature infants after extubation by pulmonary surfactant(PS).Methods A total of 80 premature infants with neonatal respiratory distress syndrome(NRDS)treated in the Maternal&Child Health Hospital of Guangxi Zhuang Autonomous Region were enrolled from March 2017 to March 2019,and were divided into observation group(n=40)and control group(n=40)randomly.Both groups were given tracheal intubation,PS and pulling out tracheal intubation.The observation group was given synchronized nasal intermittent positive pressure ventilation(SNIPPV)for respiratory support,while control group received nasal continuous positive airway pressure(NCPAP)for support.The blood gas indexes,clinical indexes,invasive respiratory support rate and complications during treatment were compared between the two groups.Results At 1 h,12 h and 24 h after ventilation,partial pressure of carbon dioxide(PaCO2)and oxygenation index(OI)in observation group were significantly lower than those in control group(P<0.05).And at 1 h and 12 h after ventilation,oxygen partial pressure(PaO2)in observation group was significantly higher than that in control group(P<0.05).Moreover,the invasive respiratory support rate and the incidence of complications in observation group were significantly lower than those in control group during treatment(20.00%vs.52.50%;22.50%vs.47.50%)(χ2=9.141,5.495,P<0.05).The invasive ventilation time,oxygen therapy time and hospitalization time in observation group were all shorter than those in control group(t=5.821,41.681,3.924,P<0.05).Conclusion Compared with NCPAP,SNIPPV can more effectively improve oxygenation of NRDS children,reduce CO2 retention,shorten ventilation support time,milking time,hospitalization time,and reduce incidence of complications.