nBiPAP和nCPAP治疗早产儿呼吸暂停疗效比较及对患儿肺功能和Gesell评分的影响

Comparison of clinical effect between nBiPAP and nCPAP in treatment of premature infants with apnea and their influences on pulmonary function and Gesell score

目的比较经鼻双水平正压通气(nBiPAP)和经鼻持续气道正压通气(nCPAP)治疗早产儿呼吸暂停的临床效果,探讨两种治疗方式对患儿肺功能及脑神经发育的影响作用。方法选择2015年3月-2016年12月在在我院新生儿重症监护室接受治疗的94例被诊断为呼吸暂停的极低出生体重早产儿作为研究对象,采用随机数字表法将其分为研究组和对照组,每组47例,分别给予nBiPAP治疗和nCPAP治疗。比较两组患儿的治疗效果及肺功能和Gesell评分变化情况。结果 (1)研究组患儿的气管插管率明显低于对照组(χ~2=4.821,P=0.028),用氧时间和住院时间比较则无显著性差异(t=0.082,0.467;P=0.478,0.317);(2)研究组患儿治疗总有效率明显高于对照组患儿(χ~2=11.220,P=0.001),两组患儿治疗过程中并发鼻压伤、气漏、腹胀、颅内出血、BPD、ROP的发生率比较均无显著性差异(P>0.05);(3)研究组患儿治疗后潮气呼气峰流速,75%、50%、25%潮气量时呼气流速,潮气量,每分钟通气量,达峰时间比和达峰容积比均明显高于对照组患儿(P<0.05);(4)治疗后两组患儿的Gesell各项评分均有明显改善(P<0.05),且治疗后研究组患儿与对照组患儿比较差异显著(P<0.05)。结论与nCPAP相比,nBiPAP治疗模式应用于早产儿呼吸暂停效果更为显著,可更好帮助改善患儿早期肺功能,提高呼吸暂停缓解率,促进早产患儿脑神经发育情况,安全性也更高,值得临床推广应用。

Objective To compare the clinical effect of biphasic continuous positive airway pressure( nBiPAP) and continuous positive airway pressure( nCPAP) in treatment of premature infants with apnea,and to investigate their effect on lung function and development of cranial nerves in children. Methods A total of 94 cases of very low birth weight premature infants who were treated in our neonatal intensive care unit were selected as the subjects from March 2015 to December 2016,and they were randomly divided into the study group treated with nBiPAP and the control group treated with nCPAP,47 cases in each group. The therapeutic effect,pulmonary function and Gesell scores of the two groups were compared. Results( 1) The endotracheal intubation rate of the study group was significantly lower than that of the control group( χ~2= 4. 821,P = 0. 028),and the use of oxygen and hospital stay had no significant difference between the two groups( t = 0. 082,0. 467;P = 0. 478,0. 317).( 2) The total treatment efficiency of the study group was significantly higher than that of the control group( χ~2= 11. 220,P = 0. 001),and there was no significant difference between the two groups in the incidence of nasal trauma,gas leakage,abdominal distension,intracranial hemorrhage,BPD or ROP( P > 0. 05).( 3) Tidal breathing peak expiratory flow,75%,50% and 25% tidal volume during expiratory flow,tidal volume,minute ventilation,peak time ratio and peak volume ratio in the study group were significantly higher than those in the control group after treatment( P < 0. 05).( 4)After treatment,the scores of Gesell of the two groups were significantly improved( P < 0. 05),and the difference between the study group and the control group was significant after treatment( P < 0. 05). Conclusion Compared with nCPAP treatment,the effect of nBiPAP treatment on apnea in premature infants is more significant,which can improve the early pulmonary function of children with apnea,improve the remission rate of premature infants,promote brain development,and has higher security. It is worthy of widely clinical application.