不同无创正压通气模式对早产儿原发性呼吸暂停的疗效比较

Comparison of the efficacy of different non-invasive positive pressure ventilation modes on apnea of prematurity in preterm infants

目的 探讨双水平气道正压通气(BiPAP)和经鼻持续气道正压通气(NCPAP)治疗早产儿原发性呼吸暂停(AOP)的效果及安全性。方法 54例AOP早产儿,随机分为观察组和对照组,各27例。观察组给予Bi PAP治疗,对照组给予NCPAP治疗。比较两组治疗前及治疗24 h后的血气指标[氧分压(PaO_(2))、二氧化碳分压(PaCO_(2))、血氧饱和度(SaO_(2))、pH值]、疗效、辅助通气时间、总用氧时间、不良反应发生情况、并发症发生情况。结果 治疗24 h后,两组PaO_(2)、PaCO_(2)、SaO_(2)、pH值均较治疗前改善,且观察组PaO_(2)(71.52±5.80)mm Hg(1 mm Hg=0.133 kPa)、SaO_(2)(91.52±1.25)%、pH值(7.42±0.03)高于对照组的(66.98±5.25)mm Hg、(90.81±0.83)%、(7.38±0.08),PaCO_(2)(38.48±2.86)mm Hg低于对照组的(41.48±4.25)mm Hg,差异均有统计学意义(P<0.05)。观察组总有效率92.59%高于对照组的70.37%,差异有统计学意义(P<0.05)。观察组辅助通气时间(7.15±5.49)d、总用氧时间(16.93±15.37)d短于对照组的(10.59±5.62)、(26.33±18.81)d,差异有统计学意义(P<0.05)。观察组鼻黏膜损伤、腹胀、气胸发生率高于对照组,但差异无统计学意义(P>0.05)。观察组颅内出血、支气管肺发育不良、坏死性小肠结肠炎、早产儿视网膜病变发生率低于对照组,但差异无统计学意义(P>0.05)。结论 AOP患儿施行BiPAP模式辅助通气较NCPAP模式能获得更好的治疗效果,未增加不良反应和并发症的发生风险。

Objective To discuss the effect and safety of bi-level positive airway pressure (BiPAP)and nasal continuous positive airway pressure ventilation (NCPAP) on apnea of prematurity in preterm infants.Methods A total of 54 preterm infants with AOP were randomly divided into observation and control groups,with 27 cases in each group.The observation group received BiPAP treatment,and the control group received NCPAP treatment.Both groups were compared in terms of blood gas indexes[arterial partial pressure of oxygen(PaO_(2)),arterial partial pressure of carbon dioxide (PaCO_(2)),oxygen saturation (SaO_(2)),pH]before treatment and after 24 h of treatment,clinical efficacy,duration of assisted ventilation,total time of oxygen administration,occurrence of adverse reactions and complications.Results After 24 h of treatment,the PaO_(2),PaCO_(2),SaO_(2),and pH in both groups improved compared with those before treatment in this group;the PaO_(2) (71.52±5.80) mm Hg(1 mm Hg=0.133 kPa),SaO_(2) (91.52±1.25)%and pH value (7.42±0.03) in the observation group were higher than (66.98±5.25) mm Hg,(90.81±0.83)%and (7.38±0.08) in the control group;the PaCO_(2) (38.48±2.86) mm Hg in the observation group was lower than (41.48±4.25) mm Hg in the control group;the differences were all statistically significant (P0.05).The incidence of intracranial hemorrhage,bronchopulmonary dysplasia,necrotizing enterocolitis,and retinopathy of prematurity in the observation group was lower than that in the control group,but the difference was not statistically significant (P>0.05).Conclusion Compared with NCPAP,BiPAP assisted ventilation can achieve better therapeutic effect in children with AOP,and does not increase the risk of adverse reactions and complications.