经鼻间歇正压通气联合微创肺表面活性物质治疗极早产儿呼吸窘迫综合征疗效分析  

Efficacy analysis of nasal intermittent positive pressure ventilation and minimally invasive surfactant therapy in very preterm infants with respiratory distress syndrome

作　　者：王柱[1] 杜岚岚[1] 陈佳[1] 周文姬[1] 段顺艳 刘颖[1] 杨杰[1] 高薇薇[1] Wang Zhu;Du Lanlan;Chen Jia;Zhou Wenji;Duan Shunyan;Liu Ying;Yang Jie;Gao Weiwei(Department of Neonatology,Guangdong Women and Children's Hospital,Guangzhou 511400,China)

机构地区：[1]广东省妇幼保健院新生儿科,广州511400

出　　处：《中华新生儿科杂志（中英文）》2022年第4期293-297,共5页Chinese Journal of Neonatology

基　　金：广东省医学科研基金项目(A2011076)。

摘　　要：目的探讨早期经鼻间歇正压通气(nasal intermittent positive pressure ventilation, NIPPV)联合肺表面活性物质(pulmonary surfactant, PS)微创给药治疗极早产儿呼吸窘迫综合征(respiratory distress syndrome, RDS)的临床疗效。方法选择2020年1~12月广东省妇幼保健院出生、新生儿重症监护病房收治的胎龄≤30周RDS极早产儿进行前瞻性随机对照研究, 随机分为NIPPV组和经鼻持续气道正压通气(nasal continuous positive airway pressure, NCPAP)组, 两种通气方式同时微创应用PS。比较两组患儿给药过程中不良反应、给药后2 h动脉血二氧化碳分压、72 h内气管插管率、PS≥2次使用率、频繁呼吸暂停发生率、呼吸支持治疗相关数据及各种并发症的发生情况。结果纳入RDS极早产儿62例, NIPPV组32例, NCPAP组30例。与NCPAP组相比, NIPPV组微创应用PS过程中心动过缓(6.3%比30.0%)、脉搏氧饱和度下降(12.5%比40.0%)及呼吸暂停(6.3%比30.0%)发生率更低, 差异均有统计学意义(P<0.05);两组反流发生率差异无统计学意义(P>0.05);微创给PS后NIPPV组2 h 动脉血二氧化碳分压[40.1(38.2, 43.8)mmHg比48.3(44.1, 50.0)mmHg]、72 h内插管率(6.3%比30.0%)、PS使用≥2次比例(6.3%比30.0%)及频繁呼吸暂停发生率(6.3%比30.0%)低于NCPAP组, 差异均有统计学意义(P<0.05);两组有创通气时间、无创通气时间、总用氧时间、中-重度支气管肺发育不良、脑室内出血(≥Ⅲ度)、脑室周围白质软化、早产儿视网膜病(≥Ⅱ期)、坏死性小肠结肠炎(≥Ⅱb)期、鼻损伤、气漏并发症、死亡发生率比较, 差异均无统计学意义(P>0.05)。结论 NIPPV模式下微创应用PS可降低用药过程中不良反应发生率, 且并未增加呼吸支持时间及早产儿常见并发症发生率, 值得临床应用。Objective To study the efficacy of nasal intermittent positive pressure ventilation(NIPPV)and minimally invasive surfactant therapy(MIST)in very preterm infants with respiratory distress syndrome(RDS).Methods From January to December 2020,very preterm infants(gestation age≤30 weeks)with RDS born and treated in our hospital were randomly assigned into NIPPV group and nasal continuous positive airway pressure(NCPAP)group.Both groups were treated with MIST technique.The following items were compared between the two groups:adverse reactions during MIST,partial pressure of carbon dioxide(PaCO2)at 2 h after MIST,the incidences of intubation within 72 h,two or more doses of pulmonary surfactant(PS),frequent apnea,other complications and the parameters of respiratory support treatment.Results A total of 62 cases were included,with 32 in the NIPPV group and 30 in the NCPAP group.Compared with the NCPAP group,the NIPPV group had lower incidences of bradycardia(6.3%vs.30.0%),decreased oxygen saturation(12.5%vs.40.0%)and apnea(6.3%vs.30.0%)during MIST(P<0.05).No significant difference existed in the incidence of regurgitation(P>0.05).PaCO2 at 2 h after MIST[40.1(38.2,43.8)mmHg vs.48.3(44.1,50.0)mmHg],the incidences of intubation within 72 h(6.3%vs.30.0%),two or more doses of PS(6.3%vs.30.0%)and frequent apnea(6.3%vs.30.0%)in NIPPV group were lower than NCPAP group(P<0.05).No significant differences existed between the two groups on the following items:the durations of invasive ventilation,non-invasive ventilation,oxygen therapy,the incidences of bronchopulmonary dysplasia,intraventricular hemorrhage(≥Ⅲ),periventricular leukomalacia,retinopathy of prematurity(≥Ⅱ),necrotizing enterocolitis(≥Ⅱb),nasal injury,air leak and death(P>0.05).Conclusions Combining NIPPV and MIST can reduce the incidence of adverse reactions during PS administration without increasing respiratory support duration and common complications in preterm infants.It is recommended for clinical use.

关 键 词：经鼻间歇正压通气 微创 肺表面活性物质 婴儿 早产 呼吸窘迫综合征 新生儿 

分 类 号：R722.6[医药卫生—儿科]