经鼻无创间歇指令通气与双水平正压通气治疗早产儿呼吸窘迫综合征的比较

Comparative evaluation of nasal noninvasive intermittent positive pressure ventilation and nasal bi-level positive airway pressure in the treatment of neonatal respiratory distress syndrome

目的:分析比较经鼻无创间歇指令通气(NIPPV)与双水平正压通气(nBiPAP)治疗早产儿呼吸窘迫综合征(NRDS)的疗效。方法:分析166例NRDS患儿的临床资料,依照完全随机分组法将其分为NIPPV组83例和nBiPAP组83例。NIPPV组使用NIPPV通气,nBiPAP组采用nBiPAP通气。分析治疗前及治疗2 h、24 h、72 h后两组血气分析检验结果,统计两组治疗时间(氧暴露时间、上机时间、住院天数),观察治疗后2个月内两组近远期并发症情况。结果:治疗72 h后,两组PaO_( 2)、SaO_( 2)、MAP、OI、a/APO_( 2)水平均较治疗前有显著升高,差异有统计学意义(P<0.05),且NIPPV组PaO_( 2)、SaO_( 2)、OI、a/APO_( 2)明显高于同一时间nBiPAP组,两组FiO_( 2)、PaCO_( 2)水平均较治疗前有显著降低,差异有统计学意义(P<0.05),且NIPPV组FiO_( 2)、PaCO_( 2)明显低于同一时间nBiPAP组,差异有统计学意义(P<0.05)。NIPPV组氧暴露时间、上机时间、住院天数均显著低于nBiPAP组,差异有统计学意义(P<0.05)。治疗后2个月内,NIPPV组BPD发生率显著低于nBiPAP组,差异有统计学意义(P<0.05),NIPPV组气漏综合征、腹胀发生率显著高于nBiPAP组,差异有统计学意义(P<0.05),两组ROP、败血症、脑室内出血发生率比较,差异无统计学意义(P>0.05)。结论:NIPPV治疗NRDS能有效恢复患儿呼吸功能,减少通气时间,预防BPD发生,但需注意通气压力,避免气漏综合征发生,对患儿预后康复有利,而NIPPV模式治疗也会更容易导致腹胀。

Objective To analyze and compare the efficacy of nasal non-invasive intermittent positive pressure ventilation(NIPPV)and nasal bi-level positive airway pressure(nBiPAP)in the treatment of neonatal respiratory distress syndrome(NRDS).Method The clinical data of 166 children patients with NRDS were analyzed,and the patients were divided into NIPPV group(n=83)and nBiPAP group(n=83)according to completely random grouping.NIPPV group was given NIPPV ventilation and nBiPAP group was ventilated with nBiPAP.Blood gas analysis test results were analyzed in the two groups before treatment and after 2 h,24 h and 72 h of treatment.Treatment time(oxygen exposure time,ventilator time,hospital stay)was counted in the two groups.Short and long-term complications were observed in the two groups within 2 months after treatment.Results After 72 h of treatment,PaO_( 2),SaO_( 2),MAP,OI and a/APO_( 2) in the two groups were significantly higher than those before treatment(P<0.05),and PaO_( 2),SaO_( 2),OI and a/APO_( 2) in NIPPV group were significantly higher than those in nBiPAP group,and FiO_( 2) and PaCO_( 2) in the two groups were significantly lower than those before treatment(P<0.05),and FiO_( 2) and PaCO_( 2) in NIPPV group were significantly lower than those in nBiPAP group(P<0.05).Oxygen exposure time,ventilator time and hospital stay in NIPPV group were significantly lower than those in nBiPAP group(P<0.05).Within 2 months after treatment,incidence rate of BPD in NIPPV group was significantly lower than that in nBiPAP group(P<0.05),while incidence rates of air leak syndrome and abdominal distension in NIPPV group were significantly higher than those in nBiPAP group(P<0.05).There were no significant differences in incidence rates of ROP,septicemia and intraventricular hemorrhage between the two groups(P>0.05).Conclusion NIPPV for NRDS can effectively restore the respiratory function,reduce ventilation time and prevent the occurrence of BPD.However,it needs to pay attention to ventilation pressure to avoid occurrence of air leak syndrome,and it is beneficial to the prognosis and recovery,but NIPPV can also cause abdominal distension more easily.