双水平正压通气和经鼻持续呼吸道正压通气在早产儿呼吸窘迫综合征初始治疗中应用比较  

Comparison of bi-level positive airway pressure and nasal continuous positive airway pressure in primary treatment of premature infants with respiratory distress syndrome

作　　者：麦隽[1] 綦巧雯[1] 蔡琍璇[1] 林明祥[1] 展爱红[1] 林浩铨[1] 

机构地区：[1]广东省汕头市中心医院儿科,515031

出　　处：《中国妇幼保健》2015年第11期1690-1694,共5页Maternal and Child Health Care of China

基　　金：汕头市科技局科技项目〔(2014)62号-82〕

摘　　要：目的:探讨双水平正压通气(Bi PAP)和经鼻持续呼吸道正压通气(n CPAP)在早产儿呼吸窘迫综合征(RDS)初始治疗中的应用效果。方法:选取新生儿重症监护室收治的符合入选标准的RDS早产儿69例,给予气管插管、使用肺表面活性物质(Ps)、拔管后随机分为Bi PAP组36例和n CPAP组33例。监测呼吸支持后1、12、24及48 h的动脉血氧分压(Pa O2)、二氧化碳分压(Pa CO2)及氧合指数(OI);比较两组患儿生后24 h内、48 h内和72 h内的总有创呼吸支持率、无创呼吸机支持总时间和气漏综合征、BPD、NEC、颅内出血IVH发生率(三级以上)、早产儿视网膜病以及总住院时间、愈后。结果:正压通气后Bi PAP组12、24 h Pa CO2低于n CPAP组,1、12 h Pa O2及OI均高于n CPAP组,差异有统计学意义(P<0.05)。Bi PAP组行气管插管机械通气比例低于n CPAP组,但差异无统计学意义(P>0.05)。Bi PAP组患儿治疗成功率高于n CPAP组(P<0.05),两组无创通气成功者支持时间差异无统计学意义(P>0.05)。气漏综合征、BPD、NEC、脑室周围一脑室内出血、早产儿视网膜病、出生72 h后死亡或自动出院的发生率两组差异均无统计学意义(P>0.05)。结论:在早产儿RDS初始治疗中,采用Bi PAP通气模式在提高氧合作用、减少CO2潴留方面优于n CPAP通气模式,且未增加不良反应发生率。Objective： To explore the application effects of bi- level positive airway pressure（ Bi PAP） and nasal continuous positive airway pressure（ n CPAP） in primary treatment of premature infants with respiratory distress syndrome（ RDS）. Methods： Sixty- nine premature infants with RDS meeting the inclusion criteria were selected from NICU in the hospital,all the premature infants were treated with tracheal intubation and pulmonary surfactant,the premature infants were randomly divided into Bi PAP group（ 36 premature infants） and n CPAP group（ 33 premature infants） after extubation. The values of Pa O2,Pa CO2,and oxygenation index（ OI） at 1,12,24,and 48 hours after respiratory support were monitored; the indexes for comparison between the two groups included the total rates of invasive mechanical ventilation within 24,48,and 72 hours after birth,the total application time of noninvasive mechanical ventilation,the incidence rates of air- leak syndrome,bronchopulmonary dysplasia（ BPD）,necrotizing enterocolitis（ NEC）,intraventricular hemorrhage（ IVH） above grade3 and retinopathy of prematurity,the total hospitalization time,and prognosis. Results： The values of Pa CO2 at 12 and 24 hours after positive pressure ventilation were statistically significantly lower than those in Bi PAP group,the values of Pa O2 and OI at 1 and 12 hours after positive pressure ventilation were statistically significantly higher than those in n CPAP group（ P〉 0. 05）. The percentage of premature infants receiving mechanical ventilation in Bi PAP group was lower than that in n CPAP group,but there was no statistically significant difference between the two groups（ P 〈0. 05）. The successful rate of treatment in Bi PAP group was statistically significantly higher than that in n CPAP group（ P 〈0. 05）. There was no statistically significant difference in the application time of noninvasive mechanical ventilation between the two groups（ P 〉0. 05）. There was no statistically significant di

关 键 词：双水平正压通气 持续呼吸道正压通气 呼吸窘迫综合征 早产儿 

分 类 号：R722.12[医药卫生—儿科]