极低出生体质量早产儿生后早期鼻塞式间歇与持续正压通气的比较  

Nasal Intermittent versus Continuous Positive Pressure Ventilation in Early Very Low Birth Weight Infants

作　　者：高薇薇[1] 柳国胜[2] 许芳[1] 杜岚岚[1] 李伟涛[1] 张晓玲[1] 陈佳[1] 林兴[1] 

机构地区：[1]广东省妇幼保健院新生儿科,广东广州511440 [2]暨南大学附属第一医院新生儿科,广东广州510632

出　　处：《中山大学学报（医学科学版）》2015年第2期231-236,共6页Journal of Sun Yat-Sen University:Medical Sciences

摘　　要：【目的】比较在极低出生体质量（VLBW）早产儿中早期使用鼻塞式间歇正压通气（NIPPV）与鼻塞式持续正压通气（NCPAP）的临床疗效。【方法】前瞻性随机对照试验,出生胎龄26＋0~32＋0,出生体质量≤1 500 g的患儿生后随机分入NIPPV组或NCPAP组。比较两组的呼吸支持治疗数据和临床转归情况。【结果】共200例患儿完成实验,至纠正胎龄36周时比较,支气管肺发育不良发生率组间比较无统计学差异（39%vs 45%,P〉0.05）;NIPPV组患儿生后3 d时有创机械辅助通气使用率较NCPAP组低,（23%vs 41%,P〈0.05）;肺表面活性物质治疗较NCPAP组少（33%vs 48%,P〈0.05）。NIPPV组患儿有创通气时间,总用氧时间均低于NCPAP组,组间比较均有统计学差异。其他临床并发症组间比较无统计学差异。【结论】与NCPAP比较,VLBW早产儿早期使用NIPPV治疗虽未能减少BPD的发生,但仍是可供临床选择的另一种安全和有效的无创辅助通气治疗方式。【Objective】 To compare the efficacy and safety of nasal intermittent positive pressure ventilation（NIPPV） with nasal continuous positive airway pressure（NCPAP） in early very low birth weight preterm infants. 【Methods】 A prospective randomized study was performed. The gestational age 26＋0~ 32＋0, birth weight≤ 1 500 g infants were randomized to NIPPV or NCPAP group soon after birth. The clinical outcomes were compared. 【Result】 200 patients were involved in the study. The rates of BPD did not differ significantly between the NIPPV and NCPAP groups（39% vs 45%, P〉0.05） Infants who received NIPPV treatment within the early72 hours of life had less frequently required intubation（23% vs 41%, P〈0.05） and less pulmonary surfactant treatment.（33% vs48%, P〈0.05）. The duration of endotracheal mechanical ventilation and duration of supplemental oxygen were all less in NIPPV group. Other adverse neonatal outcomes did not differ significantly between two groups. 【Conclusion】 Early NIPPV did not significantly reduce BPD, as compared with NCPAP. However, it is another effective and safe respiratory supportifor VLBW preterm infants.

关 键 词：极低出生体质量 早产儿 鼻塞式间歇正压通气 鼻塞式持续气道正压 支气管肺发育不良 

分 类 号：R72[医药卫生—儿科]