双水平正压通气和持续气道正压通气在早产儿呼吸窘迫综合征中应用的比较  

Comparative study on application of Duo positive airway pressure and continuous positive airway pressure in preterm neonates with respiratory distress syndrome

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

机构地区：[1]上海第二军医大学研究生院,上海200433 [2]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

出　　处：《中国当代儿科杂志》2012年第12期888-892,共5页Chinese Journal of Contemporary Pediatrics

基　　金：国家自然科学基金(NO.30973210)

摘　　要：目的对患有新生儿呼吸窘迫综合征(RDS)的早产儿早期使用双水平正压通气(DuoPAP)和经鼻持续气道正压通气(NCPAP)模式在降低有创呼吸支持率和支气管肺发育不良(BPD)发生率方面进行比较分析。方法该试验为单中心随机对照试验,将胎龄30～35周患有RDS生后6 h内的早产儿随机分为早期使用DuoPAP组(n=34)和早期使用NCPAP组(n=33),若这两种方式不能维持则使用气管内插管、呼吸机辅助呼吸,肺表面活性物质作为急救药物。观察患儿生后24 h、48 h及72 h内的总插管有创呼吸支持率、支气管肺发育不良(BPD)发生率及使用无创呼吸支持后1、12、24、48、72 h二氧化碳分压(PaCO2)、氧分压(PaO2)及氧合指数(OI)。结果 DuoPAP组48 h内、72 h内总插管有创呼吸支持率明显低于NCPAP组(P<0.05)。两组BPD发生率未见不同(P>0.05)。DuoPAP组OI无创呼吸支持后1、12、24、48、72 h均高于NCPAP组(均P<0.05)。DuoPAP组PaCO2在无创呼吸支持后1、12、24 h明显小于NCPAP组(P<0.05);DuoPAP组PaO2在无创呼吸支持后1、12 h明显大于NCPAP组(P<0.05)。结论早期使用DuoPAP与NCPAP相比,可明显降低RDS患儿插管有创呼吸支持率,值得推广。Objective To determine whether early application of Duo positive airway pressure（DuoPAP）,in comparison with nasal continuous positive airway pressure（NCPAP）,can reduce the need for endotracheal intubation and mechanical ventilation and decrease the incidence of bronchopulmonary dysplasia（BPD） in preterm neonates with respiratory distress syndrome（RDS）.Methods In a single-center,randomized controlled trial,preterm neonates（gestational ages 30-35 weeks） with RDS were randomly assigned to receive DuoPAP（n=34） or NCPAP（n=33）within 6 hours of birth.If the two noninvasive ventilations were not effective,endotracheal intubation and mechanical ventilation were used,and pulmonary surfactant was administered as rescue therapy.The total invasive respiratory support rate and incidence of BPD within 24,48 and 72 hours of birth were observed.The two groups were compared in terms of PaCO2,PaO2 and oxygenation index（OI） at 1,12,24,48 and 72 hours after using the noninvasive respiratory support.Results The total invasive respiratory support rates within 48 and 72 hours after birth were significantly lower in the DuoPAP group than in the NCPAP group（P〈0.05）.There was no difference in the incidence of BPD between the two groups（P〈0.05）.The OI in the DuoPAP group was significantly higher than in the NCPAP group at 1,12,24,48 and 72 hours after noninlasive respiratory support（P〈0.05）.The DuoPAP group showed significantly lower PaCO2 than the NCPAP group at 1,12,and 24 hours after noninvasive respiratory support（P〈0.05）.PaO2 was significantly higher in the DuoPAP group than in the NCPAP group at 1 and 12 hours after noninvasive respiratory support（P〈0.05）.Conclusions Compared with NCPAP,early application of DuoPAP can decrease the need for endotracheal intubation and mechanical ventilation in preterm neonates with RDS,showing promise for broad use.

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 持续气道正压 支气管肺发育不良 新生儿 

分 类 号：R722.6[医药卫生—儿科]