双水平正压通气在早产儿呼吸窘迫综合征治疗中的应用  

A clinical trial of duo positive airway pressure ventilation versus nasal continuous positive airway pressure in treatment of preterm infant with neonatal respiratory distress syndrome after INSURE

作　　者：戴立英[1,2] 张健 王琍琍[1] 

机构地区：[1]安徽医科大学第一附属医院,安徽合肥230000 [2]安徽省儿童医院,安徽合肥230051

出　　处：《临床儿科杂志》2014年第8期732-735,共4页Journal of Clinical Pediatrics

摘　　要：目的探讨无创双水平正压通气(DuoPAP)在早产儿呼吸窘迫综合征(NRDS)中的临床应用效果。方法选择2012年12月至2013年12月新生儿重症监护病房65例NRDS患儿,随机分为DuoPAP组34例,鼻塞式持续气道正压通气(nCPAP)组31例,采用气管插管-应用肺表面活性物质(PS)-拔出气管插管技术,监测呼吸支持后1、12、24及72 h的血气pH值、血氧分压(PaO2)、二氧化碳分压(PaCO2)及氧合指数(OI);分别记录72 h两组呼吸暂停、肺气漏、重复应用PS及无创通气失败例数,并进行统计学分析。结果 DuoPAP组在无创呼吸支持后1、12、24 h的OI均高于nCPAP组,PaCO2值均低于nCPAP组,PaO2也在无创呼吸支持后1、12 h大于nCPAP组,差异均有统计学意义(P<0.01)。DuoPAP组72 h内无创通气失败、呼吸暂停发生率明显低于nCPAP组,差异均有统计学意义(P<0.05);两组肺气漏、重复使用PS的差异无统计学意义(P均>0.05)。结论 DuoPAP治疗NRDS与nCPAP相比能更快改善氧合,减少CO2潴留,减少有创机械通气比例。Objective To explore the efficacy of duo positive airway pressure ventilation in treating preterm infant with neonatal respiratory distress syndrome （RDS）. Methods 65 preterm infants admitted to the neonatal intensive care unit from December 2012 to December 2013 were randomly divided into DuoPAP group （34 cases） or NCPAP （31 cases） group. Blood gas analysis（pH value, PaO2, PaCO2 and OI） at lh, 12h, 24h, and 72h, and incidence of apnea, pulmonary air leak, repeated application of pulmonary surfactant and non-invasive ventilation failure at 72h in the two groups were measured and compared after using intubate surfactant extubate （INSURE）. Results OI after non-invasive ventilation at lh, 12h, and 24h was significantly higherin DuoPAP group than that in NCPAP group P〈0.01）. PaCO2 after non-invasive ventilation at lh, 12h, 24hand 72h was significantly lower in DuoPAP group than that in NCPAP group （P〈0.01）. PaO2 after non-invasive ventilation at lh and 12h was higher in DuoPAP group than that in NCPAP group, and there was significant difference between the two groups （P〈0.01）. The incidence of non-invasive ventilation failure, apnea in 72h was lower in DuoPAP group than that in NCPAP group, and there was significant difference between the two groups （P〈0.05）. Conclusions Compared with NCPAP, DuoPAP is more feasible for improving oxygenation, decreasing the need for mechanical ventilation in 72h in preterm infants with neonatal RDS.

关 键 词：双水平正压通气 持续气道正压通气 新生儿呼吸窘迫综合征 早产儿 

分 类 号：R722.6[医药卫生—儿科]