无创正压通气对早产儿血浆B型尿钠肽和右心室Tei指数的影响  

Effects of non-invasive positive pressure ventilation on plasma B-type natriuretic peptide level and Tei index of right ventricle in preterm infants

作　　者：金宝[1] 杨波 雷红林 李丽[1] 任漪 赵丹丹 黄迪 王乐瑶 高翔羽[1] Jin Bao;Yang Bo;Lei Honglin;Li Li;Ren Yi;Zhao Dandan;Huang Di;Wang Leyao;Gao Xiangyu(Department of Neonatology,Xuzhou Central Hospital(the Xuzhou Clinical College of Xuzhou Medical University),Xuzhou 221009,China)

机构地区：[1]徐州市中心医院(徐州医科大学徐州临床学院)新生儿科,徐州221009

出　　处：《中华全科医师杂志》2022年第9期859-865,共7页Chinese Journal of General Practitioners

基　　金：徐州市科技局重点研发计划(社会发展KC18188);江苏省妇幼健康科研项目(F201752);江苏省卫生健康委科研项目(Z2020060)。

摘　　要：目的了解无创正压通气对早产儿血浆B型尿钠肽(BNP)和右心室Tei指数等心功能指标的影响。方法选自徐州市中心医院新生儿重症监护病房2018年12月至2020年10月收治的胎龄<34周、诊断呼吸窘迫综合征、需要给予并适合使用无创正压通气的早产儿,采用随机数字表法分为经鼻持续气道正压通气(NCPAP)组(46例,初始给予NCPAP呼吸支持)和双水平气道正压通气(BiPAP)组(49例,初始给予BiPAP呼吸支持);并选择胎龄<34周、不需要无创正压通气的早产儿作为对照组(42例)。监测NCPAP组和BiPAP组无创正压通气0~12 h、48~60 h的血浆BNP、右心室Tei指数、平均气道压和氧指数;监测对照组入院0~12 h、48~60 h的血浆BNP、右心室Tei指数。结果(1)NCPAP组和BiPAP组无创正压通气后48~60 h,血浆BNP和右心室Tei指数均高于通气后0~12 h[NCPAP组(287.5±155.5)比(179.9±102.3)ng/L、(0.43±0.08)比(0.38±0.06),BiPAP组(303.1±135.4)比(186.5±95.6)ng/L、(0.45±0.08)比(0.39±0.06);t=6.00、3.34、7.47、4.48,均P<0.05];对照组入院48~60 h与0~12 h血浆BNP和右心室Tei指数差异均无统计学意义[(181.9±86.8)比(169.5±78.9)ng/L、(0.34±0.05)比(0.36±0.05),t=0.83、-1.59,均P>0.05]。(2)无创正压通气后48~60 h,NCPAP组和BiPAP组组间血浆BNP和右心室Tei指数差异均无统计学意义(均P>0.05),但均高于对照组入院48~60 h(均P<0.05)。(3)NCPAP组和BiPAP组无创正压通气后48~60 h,平均气道压和氧指数均略低于通气后0~12 h,但差异均无统计学意义[NCPAP组(6.8±1.2)比(7.0±1.3)cmH2O(1 cmH2O=0.098 kPa)、(5.7±2.1)比(6.1±2.3),BiPAP组(7.0±1.3)比(7.2±1.2)cmH2O、(5.5±2.0)比(5.8±2.1);t=-1.05、-0.80、-1.88、-0.67,均P>0.05],且两组间比较差异亦无统计学意义(均P>0.05)。(4)无创正压通气后48~60 h,血浆BNP与平均气道压呈较弱的正相关性(r=0.48,P<0.001),右心室Tei指数与平均气道压不存在相关性(r=0.17,P=0.119)。结论无创正压通气后48~60 h,早产儿血浆BNPObjective To investigate the effects of non-invasive positive pressure ventilation(NPPV)on plasma B-type natriuretic peptide(BNP)level and Tei index of right ventricle in preterm infants.Methods Premature infants of gestational age<34 weeks with respiratory distress syndrome who were admitted in Neonatal Intensive Care Unit of Xuzhou Central Hospital and requiring for NPPV from December 2018 to October 2020,were enrolled in the study.Patients were randomly divided into two groups 46 patients received nasal continuous positive airway pressure ventilation(NCPAP group)and 49 patients received bi-level positive airway pressure ventilation(BiPAP group);42 preterm infants of gestational age<34 weeks and without NPPV were selected as the control group.The plasma BNP,Tei index of right ventricle,mean airway pressure and oxygen index at 0-12 h and 48-60 h after NPPV were monitored in NCPAP group and BiPAP group.The plasma BNP and Tei index of right ventricle at 0-12 h and 48-60 h after admission were monitored in the control group.SPSS 20.0 statistical software was used for data analysis.Results(1)The plasma BNP and Tei index of right ventricle at 48-60 h after NPPV were significantly higher than those at 0-12 h after NPPV in NCPAP group and BiPAP group[NCPAP group:(287.5±155.5)vs.(179.9±102.3)ng/L,(0.43±0.08)vs.(0.38±0.06);BiPAP group:(303.1±135.4)vs.(186.5±95.6)ng/L,(0.45±0.08)vs.(0.39±0.06);t=6.00,3.34,7.47,4.48;all P<0.05].There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h and 0-12 h after admission in the control group[(181.9±86.8)vs.(169.5±78.9)ng/L,(0.34±0.05)vs.(0.36±0.05);t=0.83,-1.59;all P>0.05].(2)There were no significant differences in the plasma BNP and Tei index of right ventricle at 48-60 h after NPPV between NCPAP group-and BiPAP group(all P>0.05),but they were significantly higher than those in control group at 48-60 h after admission(all P<0.05).(3)The mean airway pressure and oxygen index at 48-60 h after NPPV in NCPAP group and BiPAP group s

关 键 词：利钠肽 脑 心室功能 正压呼吸 婴儿 早产 

分 类 号：R722.6[医药卫生—儿科]