三种无创通气模式在早产儿呼吸窘迫综合征初始治疗中的临床应用

Clinical application of three non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome

目的:比较3种无创通气模式在早产儿呼吸窘迫综合征(RDS)初始治疗中的有效性及安全性。方法:回顾性分析2019年1月至12月本院新生儿科收治的RDS早产儿111例,按照呼吸支持方式,分为经鼻持续气道正压(NCPAP)通气组(35例)、双水平气道正压(BiPAP)通气组(30例)、经鼻间歇正压通气(NIPPV)组(46例)。比较3组患儿使用无创通气治疗前及治疗后4~6 h的pH值、二氧化碳分压(PaCO_(2))、血氧分压(PaO_(2))、P/F比值(PaO_(2)/FiO_(2)),无创通气失败率、无创通气时间、有创通气时间、氧疗时间及并发症发生率的差异。结果:3组患儿无创正压通气治疗后4~6 h的pH值、PaO_(2)、P/F比值均较治疗前明显升高,PaCO_(2)较治疗前明显降低,差异均有统计学意义(P均<0.05)。BiPAP组、NIPPV组患儿无创通气4~6 h的PaO_(2)、P/F比值均要高于NCPAP组,差异均有统计学意义(P均<0.05);BiPAP组PaCO_(2)低于NCPAP组(P<0.05);BiPAP组、NIPPV组间血气分析各项指标差异无统计学意义(P均>0.05)。与NCPAP组比较,BiPAP组、NIPPV组患儿的无创通气失败率明显降低,差异有统计学意义(P<0.0125);BiPAP组、NIPPV组间的无创通气失败率无明显差异(P>0.05)。3组患儿总无创通气时间、无创通气成功者通气时间、有创通气时间和总用氧时间的差异均无统计学意义(P>0.05),气漏综合征、支气管肺发育不良、坏死性小肠结肠炎、脑室周围-脑室内出血、早产儿视网膜病的发生率比较差异均无统计学意义(P>0.05)。结论:在早产儿RDS初始治疗中,采用NIPPV或BiPAP通气模式在提高氧合、降低5 d内气管插管率方面优于NCPAP通气模式,且未增加不良反应发生率。

Objective To evaluate the clinical effectiveness and safety of three different non-invasive ventilation strategies in initial treatment of neonatal respiratory distress syndrome(RDS).Methods A total of 111 premature infants with RDS who were admitted to the NICU from Jan 2019 to Dec 2019 were divided into nasal continuous positive airway pressure(NCPAP)group(n=35),bi-level positive airway pressure(BiPAP)group(n=30)and nasal intermittent positive pressure ventilation(NIPPV)group(n=46)as an initial respiratory support.A retrospective study was conducted to compare pH,PaCO_(2),PaO_(2),P/F value(PaO_(2)/FiO_(2))before 4 to 6 hours after treatment,the incidence of non-invasive ventilation failure,non-invasive ventilation time,invasive ventilation time,duration of oxygen therapy and the incidence of complications among the three groups.Results Four to 6 hours after treatment,the blood gas indexes of pH,PaO_(2) and P/F were significantly higher and PaCO_(2) was significantly lower than those before the treatment in the three groups(P<0.05).PaO_(2) and P/F in both BiPAP group and NIPPV group were higher than those in NCPAP group(P<0.05).PaCO_(2) was lower in BiPAP group than that in NCPAP group(P<0.05),but there were no statistical differences of the blood gas indexes between BiPAP group and NIPPV group(P>0.05).The incidence of non-invasive ventilation failure was significantly lower in the BiPAP group and NIPPV group than that in NCPAP group(P<0.0125),while no signifficant difference was observed between BiPAP group and NIPPV group(P>0.05).Moreover,no signifficant differences were found among three groups regarding non-invasive ventilation time,ventilation time of successful non-invasive ventilation,invasive ventilation time,duration of oxygen therapy and the incidence rates of bronchopulmonary dysplasia,necrotizing enterocolitis,periventricular-intraventricular hemorrhages,retinopathy of prematurity(P>0.05).Conclusion NIPPV and BiPAP as an initial respiratory support for RDS in preterm infants augment the beneficial effects of NCPAP contributing to improvement of oxygenation,reduction of the rate of intubation within five days postnatal life without the relevant complications.