经鼻间歇正压通气与经鼻持续正压通气治疗早产儿呼吸窘迫综合征的临床疗效比较

Comparison of the clinical effectiveness of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure in the treatment of respiratory distress syndrome in premature infants

目的比较早期应用非同步经鼻间歇正压通气(NIPPV)和经鼻持续正压通气(NCPAP)治疗早产儿呼吸窘迫综合征(RDS)的临床疗效差异。方法回顾性分析142例胎龄28-^(32+6)周且出生体重<2500 g早产儿的临床资料,依照入院时首选的无创呼吸模式分为NCPAP组(75例)和NIPPV组(67例),比较2组无创呼吸疗效及不良反应的差异。结果NIPPV组的气管插管率、肺部感染发生率低于NCPAP组,差异有统计学意义(P<0.05);NIPPV组喂养不耐受发生率高于NCPAP组,差异有统计学意义(P<0.05),2组实现全肠道喂养时间、肺泡表面活性剂的使用、住院时间及住院费用的差异均无统计学意义(P>0.05);NIPPV组的患儿在死亡率、慢性肺支气管发育不良(BPD)、早产儿视网膜病变(ROP)、新生儿坏死性小肠结肠炎(NEC)、动脉导管未闭(PDA)、鼻黏膜损伤、肺气漏等方面的发生率与NCPAP组的差异无统计学意义(P>0.05)。结论与NCPAP比较,NIPPV可降低机械通气使用率,并且未增加鼻黏膜损伤及严重喂养问题的发生率,因此NIPPV可作为早产儿呼吸窘迫综合征早期首选的无创通气模式。

Objective To compare the clinical effectiveness of nasal intermittent positive pressure ventilation(NIPPV)and nasal continuous positive airway pressure(NCPAP)in the treatment of respiratory distress syndrome(RDS)in premature infants.Methods A total of 142 premature infants with a gestational week of 28 weeks to^(32+6)weeks and<2500 g of birth weight were enrolled and their clinical data were retrospectively analyzed.They were divided into an NCPAP group(n=75)and an NIPPV group(n=67)according to the preferred non-invasive ventilation mode at admission.Both groups were compared for non-invasive respiratory effectiveness and adverse reactions.Results The NIPPV group presented remarkable decreases in endotracheal intubation rate and pulmonary infection incidence(P<0.05),as well as significant increases in feeding intolerance(P<0.05),compared with the NCPAP group.There were no statistical differences in total parenteral feeding time,the use of pulmonary surfactant(PS),and the length of hospitalization stay and hospitalization expenses(P>0.05).There was no statistically significant differences between the NIPPV group and the NCPAP group in the incidence of mortality,bronchopulmonary dysplasia(BPD),retinopathy of prematurity(ROP),necrotizing enterocolitis(NEC),patent ductus arteriosus(PDA),nose mucosal injury,and lung leakage(P>0.05).Conclusions Compared with NCPAP,NIPPV can reduce the utilization rate of mechanical ventilation,without increasing the incidence of nasal mucosal damage and serious feeding problems.Therefore,NIPPV can be used as the first-choice non-invasive ventilation mode in the treatment of the premature.