经鼻同步间歇指令通气在重度呼吸窘迫综合征早产儿撤机后的应用

Apllication of nasal synchronous intermittent mandatory ventilation in premature infants with severe respiratory distress syndrome after extubation

摘要:

目的 探讨重度呼吸窘迫综合征(RDS)早产儿撤机后行经鼻同步间歇指令通气(nSIMV)的临床疗效。方法 回顾性分析2013 年1 月至2015 年5 月新生儿重症监护病房住院的126 例RDS 早产儿的临床资料。2013 年1 月至2014 年3 月住院患儿采用经鼻持续气道正压通气(nCPAP)(61 例),而2014 年4 月至2015 年5 月住院患儿采用nSIMV(65 例)。比较两组治疗后血气分析指标、撤机失败率与原因及并发症的差异。结果 通气治疗4 h 后,nSIMV 组pH 值、氧分压(PaO₂)、血氧饱和度(SaO₂)和氧合指数(OI)均高于nCPAP 组(均P<0.05);nSIMV 组二氧化碳分压(PaCO₂)低于nCPAP 组(P<0.05)。nSIMV 组和nCPAP 组撤机失败率分别是9%(6/65)和30%(18/61)(P<0.05),其撤机失败的原因主要有低氧血症(2% vs 5%,P>0.05)、高碳酸血症(6% vs 11%,P>0.05)和呼吸暂停(2% vs 13%,P<0.05)。两组患儿在呼吸机支持时间、全肠道喂养时间、恢复出生体重时间和总住院时间上比较差异无统计学意义(P>0.05)。治疗后nSIMV 组腹胀发生率明显低于nCPAP 组(9% vs 30%,P<0.05),但两组喂养不耐受、坏死性小肠结肠炎、脑室内出血、早产儿视网膜病变和支气管肺发育不良的发生率比较差异无统计学意义(P>0.05)。结论 重度RDS 早产儿撤机后采用nSIMV 不仅明显改善肺通气功能,降低撤机失败率,且治疗后胃肠道副反应小,不增加并发症的发生,在临床值得推广。

Abstract:

Objective To study the clinical efficacy of nasal synchronous intermittent mandatory ventilation (nSIMV) in premature infants with severe respiratory distress syndrome (RDS) after extubation. Methods A retrospective analysis on the clinical date of 126 premature infants with severe RDS who were hospitalized in the NICU between January 2013 and May 2015 was performed. Sixty-one premature infants who were hospitalized in the NICU between January 2013 and March 2014 received nasal continuous positive airway pressure (nCPAP) (nCPAP group) and 65 premature infants who were hospitalized in the NICU between April 2014 and May 2015 received nSIMV (nSIMV group). The blood gas analysis indexes, the rate of extubation failure, the causes of extubation failure and the incidence of complications were compared between the two groups. Results After 4 hours of treatment, the pH value, PaO₂, SaO₂ and oxygenation index in the nSIMV group were significantly higher than in the nCPAP group (P<0.05), meanwhile, the PaCO₂ in the nSIMV group were significantly lower than in the nCPAP group (P<0.05). The rates of extubation failure in the nSIMV and nCPAP groups were 9% (6/65) and 30% (18/61) respectively (P<0.05). The extubation failure in the nSIMV and nCPAP groups was caused by hyoxemia (2% vs 5%; P>0.05), hypercapnia (6% vs 11%; P>0.05) and apnea (2% vs 13%; P<0.05). There were no differences in respirator support time, full enteral feeding time, the time to regain birth weight and the length of hospitalization between two groups (P>0.05). After treatment, the incidence of abdominal distension in the nSIMV group was significantly lower than in the nCPAP group (9% vs 30%; P<0.05) and there were no differences in the incidences of feeding intolerance, necrotizing enterocolitis, intraventricular hemorrhage, retinopathy of prematurity and bronchopulmonory dysplasia between the two groups. Conclusions nSIMV for premature infants with severe RDS after extubation not only significantly improves lung function and reduces the rate of extubation failure, also results in a lower incidence of gastrointestinal side effects and does not increase the incidence of complications.