无创高频振荡通气和双水平正压通气在早产儿呼吸窘迫综合征中的临床应用效果比较研究

摘要

目的 比较经鼻无创高频振荡通气(NHFOV)和双水平正压通气(DuoPAP)在早产儿呼吸窘迫综合征(RDS)中的临床应用效果.方法 选取2016年6月—2017年5月新乡市中心医院新生儿重症监护病房收治的65例早产儿为研究对象,采用随机数字表法分为NHFOV组33例,DuoPAP组32例.比较两组患儿一般情况,无创呼吸支持前、无创呼吸支持后1、12、24、48、72 h动脉血氧分压(PaO2)、二氧化碳分压(PaCO2)及氧合指数(OI), 72 h内呼吸暂停发生率、有创呼吸支持率、无创呼吸支持时间、总用氧时间、猪肺磷脂注射液重复使用率、肺气漏、支气管肺发育不良(BPD)、新生儿坏死性小肠结肠炎(NEC)、脑室周围白质软化(PVL)发生率及死亡率.结果 两组患儿性别、出生体质量、发病时间、胎龄、产前使用激素情况、猪肺磷脂注射液使用时间、剖宫产率及RDS分级比较,差异无统计学意义(P>0.05).两组患儿PaCO2比较,差异有统计学意义(P<0.05),PaO2、OI比较,差异无统计学意义(P>0.05).不同时间点PaO2、PaCO2及OI比较,差异有统计学意义(P<0.05).组别和时间在PaCO2上存在交互作用(P<0.05),组别和时间在PaO2及OI上不存在交互作用(P>0.05).NHFOV组呼吸暂停发生率低于DuoPAP组,差异有统计学意义(P<0.05);NHFOV组与DuoPAP组有创呼吸支持率、无创呼吸支持时间、总用氧时间、猪肺磷脂注射液重复使用率、肺气漏、BPD、NEC、PVL发生率及死亡率比较,差异无统计学意义(P>0.05).结论 在RDS的初始治疗中,NHFOV与DuoPAP相比可以更好减少CO2潴留和呼吸暂停发生率,且不增加不良反应发生率,是安全有效的通气方式.%Objective To compare the efficacy of nasal noninvasive high-frequency oscillatory ventilation (NHFOV) and duo positive airway pressure ventilation(DuoPAP) for premature infants with respiratory distress syndrome (RDS). Methods From June 2016 to May 2017,we enrolled 65 preterm infants with RDS who received medical care from NICU, Xinxiang Central Hospital and divided them into NHFOV group(33 cases receiving NHFOV) and DuoPAP group (32 receiving DuoPAP) by a random number table.We compared both groups' baseline characteristics,arterial partial pressure of oxygen (PaO2),arterial partial pressure of carbon dioxide (PaCO2),and oxygenation index (OI) at 0,1,12,24,48,72 h after receiving respiratory support,incidence of apnea within 72 h after receiving respiratory support,rate of invasive respiratory support,duration of noninvasive respiratory support,total duration of oxygen inhalation,repeated use of poractant alfa injection,incidence of pulmonary air leak (PAL),bronchopulmonary dysplasia(BPD),neonatal necrotizing enterocolitis (NEC), periventricular leukomalacia (PVL) and mortality.Results Sex,birth weight,onset time of RDS,gestational age,maternal use of hormone before delivery,duration of using poractant alfa injection,prevalence of birth by cesarean section,and RDS classification did not differ significantly between the groups(P>0.05).Moreover,mean PaO2and OI were similar in both groups (P>0.05).However,significant differences between the groups were found in mean PaCO2(P<0.05).PaO2、PaCO2、OI differed at different time point( P<0.05).Treatment regimen and duration produced significant interaction effect on PaCO(2P<0.05), but not on PaO2and OI(P>0.05).The incidence of apnea was much lower in NHFOV group compared with DuoPAP group (P<0.05).In addition,both groups showed no significant differences in the rate of invasive respiratory support,duration of noninvasive respiratory support,total duration of oxygen inhalation,repeated use of poractant alfa injection and incidence of PAL,BPD,NEC,PVL and mortality(P>0.05).Conclusion Compared with DuoPAP,NHFOV is more safe and effective for initial treatment of preterm infants with RDS,for it can better reduce CO2retention and decrease the risk of having apnea without increasing the incidence of adverse events.