不同无创通气模式在早产儿呼吸窘迫综合征初始治疗中的应用研究

*Application study of different non-invasive ventilation modes in the initial treatment of premature infants with respiratory distress syndrome

目的比较经鼻持续气道正压通气(NCPAP)、经鼻间歇正压通气(NIPPV)、经鼻加温湿化高流量氧疗(HFNC)在早产儿呼吸窘迫综合征(RDS)初始治疗中的应用效果。方法选择198例RDS的早产儿为研究对象,利用随机数字表法将患儿随机分为NCPAP组(n=65)、NIPPV组(n=61)和HFNC组(n=72),分别给予3种无创通气模式(NCPAP、NIPPV、HFNC)治疗。比较各组患儿使用无创通气呼吸支持后24 h血气分析pH值、动脉血二氧化碳分压(PaCO_(2))、呼吸指数(RI)、氧合指数(P/F)等参数,比较各组患儿吸入氧浓度(FiO_(2))、无创通气使用时间、不良反应及远期并发症等情况,通过多因素Logistic回归分析法探讨无创通气失败的相关因素。结果治疗前,3组患儿的血气分析pH值、PaCO_(2)值比较,差异均无统计学意义(均P>0.05);治疗后,3组患儿血气分析pH值差异无统计学意义(P>0.05),HFNC组患儿的血气分析PaCO_(2)水平明显高于NCPAP组和NIPPV组(均P<0.05)。HFNC组患儿的RI值、24 h FiO_(2)值明显高于NCPAP组和NIPPV组,P/F值低于NCPAP组和NIPPV组(均P<0.05)。NIPPV组患儿的P/F值高于NCPAP组,24 h FiO_(2)值低于NCPAP组(均P<0.05)。3组RDS患儿在无创通气持续时间、无创通气失败改有创通气率、相关并发症发生率方面比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,无创通气模式和RDS分级是无创通气失败的独立影响因素。结论NCPAP或NIPPV通气模式在治疗中提高早产儿RDS氧合、减少CO_(2)潴留等方面优于HFNC,通气模式的选择及RDS严重程度是无创通气治疗失败的独立影响因素。

Objective To compare the application effect of nasal continuous positive airway pressure(NCPAP),nasal intermittent positive pressure ventilation(NIPPV)and high-flow nasal cannula oxygen therapy(HFNC)in the initial treatment of premature infants with respiratory distress syndrome(RDS).Methods A total of 198 premature infants with RDS were randomly divided into NCPAP group(n=65),NIPPV group(n=61)and HFNC group(n=72),and three non-invasive ventilation modes(NCPAP,NIPPV and HFNC)were given respectively.The parameters of blood gas analysis such as pH value,arterial partial pressure of carbon dioxide(PaCO_(2)),respiratory index(RI)and partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen(P/F)were compared among the groups at 24 hours after non-invasive ventilation.The fraction of inspiratory oxygen(FiO_(2)),duration of non-invasive ventilation,adverse reactions and long-term complications were compared among the groups,and the related factors of non-invasive ventilation failure were researched by multivariate Logistic regression analysis.Results Before treatment,there was no statistically significant difference in pH value and PaCO_(2) value in blood gas analysis among the three groups(all P>0.05).After treatment,there was no statistically significant difference in pH value in blood gas analysis among the three groups(P>0.05),and the PaCO_(2) level of blood gas analysis in the HFNC group was significantly higher than that in the NCPAP group and NIPPV group(all P<0.05).The RI value and 24 h FiO_(2) value in the HFNC group were significantly higher than those in the NCPAP group and NIPPV group,while the P/F value was lower than that in the NCPAP group and NIPPV group(all P<0.05).Compared with NCPAP group,the P/F value was higher and the 24 h FiO_(2) value was lower in the NIPPV group(all P<0.05).There were no statistically significant differences in the duration of non-invasive ventilation,the rate of conversion from non-invasive ventilation failure to invasive ventilation,and the incidence of related complications among the three groups(all P>0.05).The results of multivariate Logistic regression analysis showed that non-invasive ventilation mode and RDS grade were independent influencing factors for the failure of non-invasive ventilation.Conclusion NCPAP or NIPPV is superior to HFNC in improving oxygenation and reducing CO_(2) retention in premature infants with RDS.The choice of ventilation mode and the severity of RDS are independent influencing factors for the failure of non-invasive ventilation.