不同无创通气模式在早产儿呼吸窘迫综合征撤机后的应用比较

Comparison of three noninvasive ventilation modes in premature infants with respiratory distress syn⁃drome after extubation

目的探讨呼吸窘迫综合征(respiratory distress syndrome,RDS)早产儿撤机后分别应用经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)、双水平气道正压通气(bilevel positive airway pressure,BiPAP)和经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)的临床疗效。方法70例RDS早产儿依据拔管撤除呼吸机后呼吸支持方式分为NIPPV组(20例)、BiPAP组(24例)和NCPAP组(26例),分析三组患儿无创通气前后血气分析指标、1周内拔管成功率及并发症等。结果拔管前三组PaO2和PaCO2差异无统计学意义(P>0.05)。NIPPV组与BiPAP组无创通气后6 h PaO2、12 h PaO2比较差异无统计学意义(P>0.05),两组均高于NCPAP组,差异均有统计学意义(P<0.05);NIPPV组6 h PaCO2最低,NCPAP组最高,三组间两两比较差异均有统计学意义(P<0.05);NIPPV组与BiPAP组12 h PaCO2比较差异无统计学意义(P>0.05),两组均低于NCPAP组,差异均有统计学意义(P<0.05)。三组在7 d内再插管、气胸、脑室内出血和支气管肺发育不良方面差异无统计学意义(P>0.05);NIPPV组无创通气期间患儿腹胀发生率较BiPAP组和NCPAP组低,差异具有统计学意义(P<0.05)。结论作为早产儿RDS撤机后的过渡方式,NIPPV与BiPAP均能更好改善肺通气功能;在NIPPV使用中需要关注避免PaCO2过低;在BiPAP和NCPAP使用中需关注腹胀的发生。

Objective To investigate the clinical efficacy of nasal intermittent positive pressure ventilation(NIPPV),bilevel positive airway pressure(BiPAP)and nasal continuous positive airway pressure(NCPAP)in premature infants with respiratory distress syndrome(RDS)after extubation.Methods According to the respiratory support methods after extubation,70 premature infants with RDS were divided into NIPPV group(n=20),BiPAP group(n=24),and NCPAP(n=26).The indexes of blood gas analysis,success rate of extubation within one week and complications before and after noninvasive ventilation were analyzed.Results There was no significant differ⁃ence in PaO2 and PaCO2 among the three groups before extubation(P>0.05).There was no statistically significant difference between NIPPV group and BiPAP group in terms of 6 h PaO2 and 12 h PaO2 after non⁃invasive ventila⁃tion(P>0.05),which were higher than those in NCPAP group(P<0.05),indicating statistical significance.6 h PaCO2 was the lowest in the NIPPV group,and the highest in the NCPAP group and pairwise comparison among the three groups was statistically significant(P<0.05).There was no significant difference in 12 h PaCO2 between the NIPPV group and the BiPAP group(P>0.05),which was lower than that in the NCPAP group(P<0.05).The incidence of abdominal distension in the NIPPV group during noninvasive ventilation was significantly lower than that in the BiPAP group and the NCPAP group(P<0.05).The incidences of internal extubation failure within 7 days,pneumothorax,intracerebral hemorrhage,or bronchopulmonary dysplasia were not statistically significant in the three groups(P>0.05).The incidence of abdominal distension in the NIPPV group was lower than that in the BiPAP group or the NCPAP group,and the difference was statistically significant(P<0.05).Conclusion As a transitional mode after the extubation in premature infants with RDS,both NIPPV and BiPAP can improve the pulmonary ventilation function.Attention should be paid to avoid low PaCO2 in the use of NIPPV.The use of BiPAP or NCPAP requires attention to the occurrence of abdominal distension.