双水平正压通气和经鼻持续气道正压通气在早产儿呼吸窘迫综合征撤机后应用的比较

摘要

目的 探讨重度新生儿呼吸窘迫综合征(RDS)早产儿撤机后使用双水平正压通气(DuoPAP)和持续气道正压通气(NCPAP)模式相比,是否可以降低撤机失败率.方法 选择2012年1 ～12月入住本院早产儿重症监护病房、胎龄29 ～ 34周、需要有创呼吸、并且在生后4周内撤机的重度RDS早产儿,撤机后随机分为DuoPAP组和NCPAP组,若应用这两种方式不能维持则再次气管插管呼吸机辅助呼吸.主要观察指标为撤机失败率、失败原因以及使用无创呼吸支持后1、12、24、48、72 h二氧化碳分压(PaCO2)、氧分压(PaO2)和氧合指数(OI).结果 共入选69例RDS早产儿,DuoPAP组35例,NCPAP组34例.DuoPAP组与NCPA组比较,撤机失败率降低(11.4％比35.3％)；12、24 h OI升高[12 h:(228.1±44.4)比(204.2±44.6),24 h:(254.6±39.5)比(230.4±44.4)],PaCO2(mm Hg)降低[12 h:(35.1±8.3)比(40.5±8.9),24 h:(36.8±8.4)比(42.1±8.8)]；12 h PaO2(mm Hg)升高[(89.0±12.5)比(74.5±13.8)],P均＜0.05.两组总用氧时间、有创呼吸支持时间、气胸、坏死性小肠结肠炎和重度脑室内出血发生率差异均无统计学意义(P＞0.05).结论 与使用NCPAP相比,撤机后使用DuoPAP可明显降低重度RDS患儿撤机失败率,值得推广.%Objective To compare extubation failure rate in preterm neonates with severe respiratory distress syndrome (RDS) receiving duo positive airway pressure (DuoPAP) ventilation with nasal continuous positive airway pressure (NCPAP) ventilation.Methods Infants (gestational age 29-34 weeks,admitted to NICU during 2012) with severe RDS who needed endotracheal intubation and met specific predetermined criteria for extubation within 4 weeks after birth were recruited.Each infant was randomized to DuoPAP or NCPAP group soon after extubation.Extubation was deemed successful if no re-intubation required for 72 h at least.If noninvasive ventilation was not effective,intubation and mechanical ventilation were used.The primary outcome was the rate of extubation failure within the first 72 h of extubation.PaCO2,PaO2 and Oxygenate Index (OI) were compared between the two groups at 1 h,12 h,24 h,48 h and 72 h after extubation.Results A total of 69 infants were enrolled (35 in DuoPAP and 34 in NCPAP group).Comparing with NCPAP group,the rate of extubation failure in DuoPAP group was lower(11.4％ vs.35.3％) ;OI at 12 h,24 h in DuoPAP group were higher [(228.1 ±44.4) vs.(204.2±44.6),(254.6±39.5) vs.(230.4±44.4)],and lower in PaCO2[(35.1 ± 8.3) vs.(40.5 ±8.9),(36.8 ±8.4) vs.(42.1 ±8.8)]; PaO2 at 12 h in DuoPAP group was significantly higer than NCPAP group [(89.0 ± 12.5) vs.(74.5 ± 13.8)].No significant differences were found between the two groups for pneumothorax,NEC,IVH (grades 3 and 4) and ROP.Conclusions DuoPAP can decrease the rate of extubation failure comparing with NCPAP in preterm neonates with severe RDS and this ventilation strategy worth promoting.