经鼻间歇正压通气在初始治疗早产儿呼吸窘迫综合征中的临床应用

Clinical application of nasal intermittent positive pressure ventilation in initial treatment of neonatal respiratory distress syndrome

摘要:

目的 探讨经鼻间歇正压通气（NIPPV）在初始治疗早产儿呼吸窘迫综合征（NRDS）中的临床有效性及安全性，探索NIPPV参数的初始设置。方法 采用随机对照研究方法，将100例NRDS早产儿随机分为NIPPV组（n=50）和经鼻持续气道正压通气（NCPAP）组（n=50），比较采用NIPPV或NCPAP初始呼吸支持治疗NRDS时，在改善CO₂潴留、改善氧合、减少再次气管插管率和再次使用肺表面活性物质（PS）率、减少有创呼吸支持时间，减少需氧时间以及并发肺气漏、腹胀、呼吸机相关性肺炎之间有无差异。结果 在给予无创呼吸支持1 h和6 h时，NIPPV组在减轻CO₂潴留、改善氧合方面明显优于NCPAP组（P<0.05）；可降低再次插管机械通气率、再次使用PS率、有创呼吸时间及FiO₂>0.21时间（均P<0.05）；呼吸暂停发生次数及呼吸机相关肺炎发生率明显低于NCPAP组（均P<0.05）；肺气漏和腹胀发生率在两组间差异无统计学意义（均P>0.05）。结论 初始即予NIPPV呼吸支持治疗早产儿NRDS，临床有效、安全，值得推广。

Abstract:

Objective To study the clinical effectiveness and safety of nasal intermittent positive pressure ventilation (NIPPV) in the initial treatment of neonatal respiratory distress syndrome (NRDS) and the initial setting of NIPPV parameters. Methods One hundred neonates with NRDS were divided into NIPPV group (n=50) and nasal continuous positive airway pressure (NCPAP) group (n=50). A randomized controlled study was conducted to compare the effectiveness of NIPPV versus NCPAP in the initial treatment of NRDS from the following aspects: reducing CO₂ retention, improving oxygenation, reducing second endotracheal intubation and second use of pulmonary surfactant (PS), reducing the duration of invasive respiratory support, reducing the duration of oxygen use, and reducing the incidence of air leak, abdominal distension and ventilator-associated pneumonia. Results After 1 and 6 hours of noninvasive respiratory support, the NIPPV group was superior to the NCPAP group with respect to the reduction in CO₂ retention and improvement in oxygenation (P<0.05); in addition, compared with the NCPAP group, the NIPPV group had significantly lower rates of second endotracheal intubation and second PS use, significantly shorter duration of invasive respiratory support and time of FiO₂ >0.21, and significantly lower incidence of apnea and ventilator-associated pneumonia (P<0.05); there were no significant differences in the incidence of air leak and abdominal distention between the two groups. Conclusions NIPPV is effective and safe in the initial treatment of NRDS and holds promise for clinical application.