经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的随机对照研究

A randomized controlled study of nasal intermittent positive pressure ventilation in the treatment of neonatal respiratory distress syndrome

摘要:

目的 比较经鼻间歇正压通气(NIPPV)与经鼻持续气道正压通气(NCPAP)在新生儿呼吸窘迫综合征(NRDS)中的疗效。方法 采用前瞻性研究方法,收集2011年3月至2012年5月符合入选标准的67例NRDS早产儿作为研究对象,随机分为NIPPV组和NCPAP组,分别实施NIPPV和NCPAP干预。比较两组患儿氧合指数(OI)、pH值、PaCO₂、呼吸支持时间、并发症、成功率、住院病死率及支气管肺发育不良(BPD)发生率等指标。结果 实际纳入研究对象62例,其中NIPPV组32例,NCPAP组30例。在无创通气治疗后1 h,NIPPV组OI高于NCPAP组(P<0.05),而pH值和PaCO₂在两组间差异无统计学意义(均P>0.05)。NIPPV组行气管插管机械通气(MVET)比例低于NCPAP组(P<0.05)。NIPPV组患儿治疗成功率高于NCPAP组(P<0.05),但两组呼吸支持时间差异无统计学意义(P>0.05)。 两组在气胸发生率、住院病死率及BPD发生率方面差异亦无统计学意义(均P>0.05)。结论 与NCPAP相比,NIPPV可显著降低NRDS早产儿行MVET比例。但尚不能证实NIPPV可显著降低NRDS早产儿住院病死率和BPD发生率。

Abstract:

Objective To compare the clinical effects of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome. Methods A prospective, randomized, controlled, single-center study was performed on 67 premature infants with NRDS between March 2011 and May 2012 and selected according to the inclusion and exclusion criteria. These premature infants were randomly assigned to receive NIPPV and NCPAP. Oxygenation index (OI), pH, PaCO₂, duration of respiratory support, complications, success rate, hospital mortality, and incidence of bronchopulmonary dysplasia (BPD) were compared between the two groups. Results Sixty-two patients were finally enrolled in the study, including 32 cases in the NIPPV group and 30 cases in the NCPAP group. After one hour of non-invasive ventilation, OI in the NIPPV group was higher than the NCPAP group (P<0.05), but there were no significant differences in pH and PaCO₂ between the two groups (P>0.05 for both). A significantly lower proportion of infants needed mechanical ventilation via endotracheal tube (MVET) when they were treated initially with NIPPV than when they were treated initially with NCPAP (P<0.05). The NIPPV group had a significant higher success rate than the NCPAP group (P<0.05), but there was no significant difference in duration of respiratory support between the two groups (P>0.05). In addition, no significant differences in incidence of pneumothorax, hospital mortality and incidence of BPD were seen between the two groups (P>0.05 for all). Conclusions Compared with NCPAP, NIPPV can significantly decrease the proportion of premature infants with NRDS in need of MVET. However, there is no evidence that NIPPV can significantly reduce hospital mortality and incidence of BPD in premature infants with NRDS.