不同无创通气模式下NRDS早产儿发生FI的危险因素分析  

The Analysis of Risk Factors for the Development of FI in Preterm Infants with NRDS Under Different Modes of Non-Invasive Ventilation

作　　者：邓洪 戴露 胡莉鸿 梁道新 尹琳琳 赵婧[1] Deng Hong;Dai Lu;Hu Lihong(Department of Paediatrics,Affiliated Hospital of North Sichuan Medical College,Nanchong,Sichuan 637000,China)

机构地区：[1]川北医学院附属医院儿科,四川南充637000

出　　处：《四川医学》2024年第4期383-388,共6页Sichuan Medical Journal

基　　金：南充市校合作-国家自然科学基金预研项目(编号:20SXZRKX0003);川北医学院省级科研项目培育(编号:CBY22-ZDA04)。

摘　　要：目的探讨NIPPV和NCPAP模式下新生儿呼吸窘迫综合征(NRDS)早产儿发生喂养不耐受(FI)的危险因素。方法回顾性分析246例首次应用NIPPV或NCPAP模式并诊断NRDS早产儿的临床资料,根据模式分为NIPPV组和NCPAP组,根据是否发生FI分为FI组和FT组,探究早产儿发生FI的危险因素。结果①NIPPV组136例、NCPAP组110例,两组在发生FI、腹胀、喂养情况、住院时间之间的差异有统计学意义(P<0.05);②FI组96例、FT组150例,两组在出生体质量及胎龄、双胎、生后首次开奶量、无创通气模式之间的差异有统计学意义(P<0.05),Logistics回归分析发现,与NCPAP模式相比,应用NIPPV模式和双胎是FI的独立危险因素(P=0.010,OR=2.105;P=0.012,OR=2.151);③在NIPPV模式中,Logistics回归分析发现,吸气峰压(PIP)≥14cmH_(2)O是FI的独立危险因素(P=0.001,OR=4.073),母亲合并妊娠期糖尿病是保护因素(P=0.004,OR=0.292)。结论早产儿发生NRDS时,使用NIPPV模式发生FI的风险高于NCPAP模式,过高的PIP及双胎是发生FI的危险因素,可延长全肠内喂养及住院时间,临床医生需密切关注。Objective To investigate the risk factors for the development of FI in preterm infants with NRDS in the NIPPV and NCPAP models.Methods Clinical data of 246 preterm infants who were first applied with either NIPPV or NCPAP and diagnosed with NRDS were retrospectively analyzed and divided into NIPPV and NCPAP groups according to the modality,and according to whether FI occured or not was divided into FI and FT groups to explore the risk factors for the occurrence of FIin preterm infants.Results Among the 136 cases in the NIPPV group and 110 cases in the NCPAP group,the differences between the two groups in terms of occurrence of FI,abdominal distension,feeding status,and length of hospital stay were statistically significant(P<0.05).②Among the 96 cases in the FI group and 150 cases in the FT group,the differences between them in terms of birth body mass,gestational age,twin births,the amount of milk opened for the first time after birth,and the mode of non-invasive ventilation were statistically significant(P<0.05),and Logistics regression analysis found that the application of the NIPPV mode and twin births were the independent risk factors for FI,comparing with the NCPAP mode(P=0.010,OR=2.105;P=0.012,OR=2.151).③Among the NIPPV models,Logistic regression analysis found that PIP≥14 cmH_(2)O was an independent risk factor for FI(P=0.001,OR=4.073),and maternal comorbid gestational diabetes was a protective factor(P=0.004,OR=0.292).Conclusion When NRDS occurs in preterm infants,the risk of FI is higher with the NIPPV model than with the NCPAP model.Excessive PIP and twin births are risk factors for the development of FI,which can prolong the duration of total enteral feeding and hospitalisation,and need to be closely monitored by clinicians.

关 键 词：经鼻间歇正压通气 经鼻持续正压通气 新生儿呼吸窘迫综合征 喂养不耐受 腹胀 呕吐 胃肠减压 

分 类 号：R722.6[医药卫生—儿科]