双水平正压通气和持续呼吸道正压通气在早产儿呼吸窘迫综合征中应用的比较  

Comparison of Duo Positive Airway Pressure and Continuous Positive Airway Pressure in Preterm Infants with Respiratory Distress Syndrome

作　　者：孔令凯[1,2] 李丽华[1] 孔祥永[1] 董建英[1] 池婧涵[1] 黄仁兴[1] 郑杨[1] 商明霞[1] 陈晓春[1] 王钰[1] 蔡娜[1] 封志纯[1] 

机构地区：[1]北京军区总医院附属八一儿童医院早产儿重症监护病房,北京100007 [2]第二军医大学研究生院,上海200433

出　　处：《实用儿科临床杂志》2012年第18期1393-1396,共4页Journal of Applied Clinical Pediatrics

基　　金：国家自然科学基金(30973210)

摘　　要：目的比较呼吸窘迫综合征(RDS)早产儿早期使用双水平正压通气(DuoPAP)和持续呼吸道正压通气(NCPAP)模式是否可以降低插管有创呼吸支持率和支气管肺发育不良(BPD)的发病率。方法本试验为单中心、随机对照研究,将胎龄30～34+6周出生6 h内的RDS早产儿随机分为早期使用DuoPAP组和早期使用NCPAP组,若这2种方式不能维持患儿生命体征则使用气管内插管,并使用肺表面活性物质气管内滴入,接呼吸机辅助呼吸,模式选择为同步间歇指令通气模式和辅助/控制模式。主要观察指标为出生24 h、48 h、72 h总插管有创呼吸支持率及BPD发病率,次要观察指标为使用无创呼吸机支持总时间、有创呼吸机使用时间、总用氧时间、气胸发病率、坏死性小肠结肠炎发病率、脑室内出血发病率(Ⅲ级以上)、全肠道喂养时间、总住院时间。结果入组的67例早产儿随机分为早期DuoPAP组(34例)和早期NCPAP组(33例),2组早产儿出生24 h总插管有创呼吸支持率比较差异无统计学意义(P=0.074),DuoPAP组48 h、72 h总插管有创呼吸支持率明显低于NCPAP组(P=0.030、0.033),但2组BPD发病率比较差异无统计学意义(P=0.979)。2组间次要观察指标比较差异均无统计学意义。结论早期使用DuoPAP可明显降低RDS患儿出生24 h后总插管有创呼吸支持率,但不能降低BPD发病率。Objective To determine whether early duo positive airway pressure （DuoPAP） in comparison to early nasal continuous positive airway pressure （NCPAP） can reduce the need for intubation and mechanical ventilation and decrease the incidence of bronchopulmonary dysplasia（BPD） in preterm infants with respiratory distress syndrome （RDS）. Methods In this single - center, randomized controlled trial,preterm infants （gestational ages were 30 -34.6 weeks ） with RDS were randomly assigned to receive early DuoPAP group or NCPAP group . If the 2 noninvasive ventilation were not effective, intubation and surfaetant were administered as rescue therapy, mechanical ventilation was used and the model of synchronized intermittent mandatory ventilation or assist control was selected by experience. The primary outcome was the morbidity of BPD and the need for mechanical ventilation within the first 24 hours,48 hours,78 hours of life and total. The secondary outcomes were total duration on DuoPAP/NCPAP, total duration on endotracheal tube ventilation, total duration on supplemental oxygen, incidence of pneumothorax, incidence of necrotizing enteroeolitis, incidence of intraventricular hemorrhage （ grade 3 and grade 4）, time to full feeds, and length of hospital stay. Results A total of 67 infants were enrolled （34 cases in early - DuoPAP group and 33 cases in ear- ly- CPAP group）. Rates of intubation in the first 24 hours did not differ significantly between the DuoPAP group and NCPAP group （P = 0. 074 ）, however, significantly more infants in the DuoPAP group remained extubated compared with those in the NCPAP group within 48 hours,72 hours （P = 0. 030,0. 033 ）. There was no difference in the incidence of BPD between the 2 groups （P = 0. 979 ）. No significant differences were noted between the 2 treatment groups for the secondary outcomes. Conclusions Early DuoPAP can decrease the need for mechanical ventilation compared with NCPAP after 24 hours and total, but it does not decrease the incidence

关 键 词：呼吸窘迫综合征 无创呼吸支持模式 双水平正压通气 持续呼吸道正压 支气管肺发育不良 婴儿 新生 

分 类 号：R722.6[医药卫生—儿科]