持续气道正压通气、经鼻双水平正压通气联合固尔苏治疗新生儿呼吸窘迫综合征的临床疗效分析

Comparison of clinical efficacy of nasal continuous positive airway pressure or nasal bilevel positive airway pressure combined with Curosurf in treatment of neonatal respiratory distress syndrome

目的对比持续气道正压通气(NCPAP)、经鼻双水平正压通气(nBiPAP)联合固尔苏治疗新生儿呼吸窘迫综合征(NRDS)的临床疗效。方法选取2017年3月至2019年3月在新密市妇幼保健院就诊的94例NRDS患儿作为研究对象,根据非随机临床同期对照研究及家属自愿原则进行分组,分为NCPAP组(NCPAP联合固尔苏治疗) 44例和nBiPAP组(nBiPAP联合固尔苏治疗) 50例。比较两组无创通气12 h、24 h、48 h血气分析指标[酸碱度(pH)、动脉血氧分压(PaO_2)、二氧化碳分压(PaCO_2)、氧合指数(OI)]、呼吸支持相关指标(24 h、48 h及72 h内有创呼吸支持率和机械通气时间、无创呼吸时间)、预后相关指标(住院时间、病死率)及并发症发生率情况。结果 (1)nBiPAP组无创通气12 h的pH、PaO_2及OI高于NCPAP组,差异有统计学意义(P<0.05);两组无创通气24 h、48 h的pH、PaO_2比较,差异无统计学意义(P>0.05)。nBiPAP组无创通气12 h、24 h的PaCO_2低于NCPAP组,差异有统计学意义(P<0.05);两组无创通气48 h的PaCO_2比较,差异无统计学意义(P>0.05)。两组无创通气24 h、48 h的OI比较,差异无统计学意义(P>0.05)。nBiPAP组24 h内有创呼吸支持率、72 h内有创呼吸支持率低于nCPAP组,差异有统计学意义(P<0.05)。(2)两组48 h内有创呼吸支持率、机械通气时间、无创呼吸时间比较,差异无统计学意义(P>0.05)。(3)两组呼吸机相关性肺炎、新生儿持续肺动脉高压、支气管肺发育不良、早产儿视网膜病发生率比较,差异无统计学意义(P>0.05)。结论 nBiPAP与NCPAP联合固尔苏治疗NRDS均有安全有效。nBiPAP相比NCPAP,可提高氧合作用,降低有创呼吸支持率。

【Objective】To compare the clinical efficacy of nasal continuous positive airway pressure(nCPAP)or nasal bilevel positive airway pressure(nBiPAP)combined with Curosurf in the treatment of neonatal respiratory distress syndrome(NRDS).【Methods】A total of 94 children patients with NRDS who were treated in our hospital from March 2017 to March 2019 were selected as the research subjects,and they were divided into nCPAP group(nCPAP combined with Curosurf)and nBiPAP group(NBiPAP combined with Curosurf)according to the non-randomized clinical control group study and the voluntary principle of family members,and 44 cases in nCPAP group and 50 cases in nBiPAP group were finally included.The blood gas analysis indexes[pH,partial pressure of oxygen(PaO_(2)),partial pressure of carbon dioxide(PaCO_(2)),oxygenation index(OI)]at 12 h,24 h and 48 h of noninvasive ventilation,respiratory support-related indicators(invasive respiratory support rate within 24 h,invasive respiratory support rate within 48 h,invasive respiratory support rate within 72 h,mechanical ventilation time,noninvasive respiratory time),prognosis-related indicators(hospital stay,mortality rate)and incidence rates of complications were compared between the two groups.【Results】The pH at 12 h of noninvasive ventilation in nBiPAP group was higher than that in nCPAP group(P<0.05),and there was no significant difference between groups at 24 h and at 48 h(P>0.05).The PaO_(2) at 12 h of noninvasive ventilation in nBiPAP group was higher than that in nCPAP group(P<0.05),and there was no statistically significant difference between groups at 24 h and at 48 h(P>0.05).The PaCO_(2) at 12 h and 24 h of noninvasive ventilation in nBiPAP group was lower than that in nCPAP group,and there was no significant difference between groups at 48 h(P>0.05).OI at 12 h of noninvasive ventilation in nBiPAP group was higher than that in nCPAP group(P<0.05),and there was no significant difference between groups at 24 h and at 48 h(P>0.05).The invasive respiratory support rate within 24 h and invasive respiratory support rate within 72 h in nBiPAP group were lower than those in nCPAP group(P<0.05),and there were no statistically significant differences in invasive respiratory support rate within 48 h,mechanical ventilation time,noninvasive respiratory time,hospital stay and mortality rate between the two groups(P>0.05).There were no statistically significant differences in the incidence rates of ventilator-associated pneumonia,persistent pulmonary hypertension of the newborn,bronchopulmonary dysplasia and retinopathy of premature infants between the two groups(P>0.05).【Conclusion】nBiPAP and nCPAP combined with Curosurf are safe and effective in the treatment of NRDS.Compared with nCPAP,nBiPAP can improve oxygenation and reduce the invasive respiratory support rate.