两种无创正压通气模式初始治疗早产儿呼吸窘迫综合征的对照研究

摘要

目的：比较两种无创正压通气模式在早产儿呼吸窘迫综合征（RDS）初始治疗中的优劣性。方法选取2011年9月至2014年6月在该院收治的 RDS 早产儿89例作为研究对象，按随机数字表随机分为两组，分为经鼻持续气道正压（nCPAP）通气组（44例）和同步鼻塞间歇正压（SNIPPV ）通气组（45例）。记录并比较两组患儿无创正压通气前，通气后1、24、72 h 的血气分析和氧合指数（OI）结果、治疗效果以及并发症的发生情况。结果SNIPPV 组在无创呼吸支持后1、24、72 h 各时间点二氧化碳分压（PaCO2）值均低于 nCPAP 组（P ＜0．05），PaO2、pH 、OI 均亦在无创呼吸支持后1 h 时大于 nCPAP 组（P＜0．05）；SNIPPV 组在拔管后低氧血症、高碳酸血症、呼吸暂停和拔管失败率均低于 nCPAP 组（P＜0．05），SNIPPV 组机械通气时间、氧疗时间也较短（P＜0．05）；但两组在正压通气相关并发症如肺出血、支气管肺发育不良（BPD）、呼吸机相关肺炎（VAP）、新生儿坏死性肠炎（NEC）以及气胸的发生率比较，差异均无统计学意义（P ＞0．05）。结论与 nCPAP 通气模式相比，SNIPPV 通气模式在提高氧合作用、减少 CO2潴留和降低拔管失败率方面具有明显优势，且不会增加并发症发生率，能更好地应用于早产儿RDS 的初始治疗。%Objective To compared the advantages and disadvantages of two modes of non‐invasive positive pressure ventilation as the initial treatment in premature infants with respiratory distress syndrome (RDS) .Methods 89 preterm infants with RDS in our hospital from September 2011 to June 2014 were selected as the research sub‐jects and randomly divided into two groups according to the random number table :nasal continuous positive airway pressure(nCPAP group ,n= 44) and the synchronized nasal intermittent positive pressure ventilation (SNIPPV group , n= 45) .The blood gas analysis and oxygen index (OI) before ventilation and at 1 ,24 ,72 h after ventilation ,curative effect and incidence of complications were recorded and compared between the two groups .Results PaCO2 at the time points of 1 ,24 ,72 h after noninvasive respiratory support in the SNIPPV group was significantly lower than that in the nCPAP group (P< 0 .05) ,while PaO2 ,pH and OI at 1 h after noninvasive respiratory support in the SNIPPV group were significantly higher than those in the nCPAP group (P< 0 .05) ,hypoxemia ,hypercapnia ,apnea and extu‐bation failure rate after extubation in the SNIPPV group were lower than those in the nCPAP group (P< 0 .05) ,the mechanical ventilation time and oxygen therapy time in the SNIPPV group were also shorter (P < 0 .05) ,but these were no statistically significant differences in the positive pressure ventilation related complications such as pulmona ‐ry hemorrhage ,bronchopulmonary dysplasia(BPD) ,ventilator‐associated pneumonia (VAP) ,necrotizing enterocolitis (NEC) and pneumothorax between the two groups(P> 0 .05) .Conclusion Compared with nCPAP ventilation mode , SNIPPV mode has obvious advantage in the aspects of increasing oxygenation ,reducing CO2 retention and decreasing the extubation failure rate without increasing the incidence probability of complications ,and can be better applied in the initial treatment of preterm newborns with RDS .