应用经鼻高流量吸氧或CPAP早产儿早期B型钠尿肽及心功能的变化

摘要

目的研究不同胎龄早产儿应用经鼻高流量吸氧或经鼻持续呼气末正压通气3天内的B型钠脲肽及心功能的变化。方法（1）120例需无创呼吸支持的早产儿根据通气方式的不同随机分为经鼻高量吸氧组（即Ⅰ组，60例）与经鼻持续呼吸气末正压通气组（即Ⅱ组，经鼻CPAP组，60例），各组再据胎龄分为A、B、C组，每组各20例，胎龄分别为28～30+6 w、31～33+6 w、34～36+6 w。（2）采用SonoSite 180 PLUS彩色多普勒超声诊断仪，探头频率为3.5～5.0 MHz。采用超声心动图法(包括二维超声心动图、M型超声心动图)，分别测定各组早产儿无创通气的第1天及第3天心功能参数，系统自动计算出每分心输出量。（3）采用试验室血生化方法分别测定各组早产儿无创通气的第1天及第3天的B型钠脲肽（BNP）。结果（1）经鼻高流量吸氧组的第1天及第3天BNP均低于经鼻CPAP辅助呼吸组相同胎龄早产儿的，差异有统计学意义，P均＜0.05。（2）经鼻高流量吸氧组与经鼻CPAP辅助呼吸组相同胎龄早产儿的第1天及第3天的心功能各项指标变化差异无统计学意义，P均＞0.05。结论经鼻CPAP辅助呼吸可能导致早产儿生后3天内血浆BNP增加，而经鼻高流量吸氧的早产儿血浆BNP无显著变化。这两种无创通气方式对早产儿心功能无明显影响。%Objective To study the changes of B type natriuretic peptide and cardiac function in the premature infants with nasal high lfow oxygen and nasal continuous positive end expiratory pressure ventilation within 3 days.Methods (1) 120 cases of premature infants with non-invasive ventilation were enrolled in this study. The infants were randomly divided into two groups by the different modes of non-invasive ventilation. The one group of nasal high flow oxygen(I, included 60 cases), another group of nasal continuous positive end expiratory pressure ventilation(II,included 60 cases ). The group of I and II were divided into A, B, C group respectively according to the gestational age. The each group included 20 cases, the gestational age were 28~30+6 w, 31~33+6 w, 34~36+6 w respectively. (2) Using SonoSite 180 PLUS color Doppler ultrasound diagnostic instrument, the frequency of probe is 3.5~5.0 MHz. The parameter of cardiac function were measured by ultrasonic cardiography (including two-dimensional ultrasound heartbeat graph, M-mode ultrasound cardiogram) in the premature infants with noninvasive ventilation on day 1 and 3 .The system automatically calculated the cardiac output. (3) The BNP of ifrst day and third day of noninvasive ventilation in preterm infants were determined by laboratory blood biochemical method.Results (1) The BNP of day 1 and 3were all lower in the group of nasal high lfow oxygen than those of the same gestational age premature infants with nasal continuous positive end expiratory pressure ventilation at ,the difference were all statistically significant,P<0.05. (2)The difference about cardiac function was not statistically significant at the first day and the third day between nasal high flow oxygen and nasal continuous positive end expiratory pressure ventilation of two groups,P>0.05.Conclusion The BNP may be increased in the premature infants with nasal CPAP within 3 days. There was no signiifcant change in plasma BNP in preterm infants with nasal high lfow oxygen. There was no significant effect on cardiac function in the two kinds of non-invasive ventilation of nasal high lfow oxygen and the nasal continuous positive airway pressure (CPAP).