摘要
目的探讨经鼻间歇正压通气(NIPPV)与气管插管同步间歇正压通气(SIPPV)治疗新生儿呼吸窘迫综合征(RDS)的疗效与安全性。方法选择本院新生儿科住院诊断为RDS且需要呼吸支持的患儿,随机分为气管插管机械通气组[SIPPV+容量保证(VG)模式]和NIPPV组,两组患儿均应用肺表面活性物质(PS)替代治疗。分别于呼吸支持0、12、24、72h记录吸入氧浓度(FiO2)、血氧饱和度(SaO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)、平均气道压(MAP),计算P/F(PaO2/FiO2)、动脉/肺泡氧分压比值(a/APO2),并比较两组并发症及转归情况。结果 NIPPV组21例,SIPPV+VG组23例,两组患儿性别、胎龄、出生体重、分娩方式、入院日龄、应用PS时间差异均无统计学意义(P>0.05)。两组在12、24、72hPaO2、FiO2、SaO2、P/F、a/APO2、MAP均较0h显著改善(P<0.001),而两组之间各指标相比差异均无统计学意义(P>0.05)。NIPPV组呼吸机相关性肺炎(VAP)和气漏的发生率均低于SIPPV+VG组(P<0.05),肺出血、颅内出血(Ⅱ～Ⅳ级)的发生率差异无统计学意义(P>0.05)。NIPPV组住院费用、上机时间均低于SIPPV+VG组,且氧暴露时间明显缩短(P<0.05)。NIPPV组有2例(9.5%)患儿因病情进一步加重改为气管插管机械通气。两组患儿住院天数、治愈率及病死率差异均无统计学意义(P>0.05)。结论 NIPPV作为治疗RDS的首选呼吸支持模式,可以迅速改善患儿的通气和氧合,与气管插管机械通气相比,可以降低VAP和气漏的发生率,降低患儿氧暴露时间,减少上机时间及住院费用。
Objective To investigate efficacy and safety of nasal intermittent positive pressure ventilation（NIPPV） and conventional positive pressure ventilation（SIPPV）for neonatal respiratory distress syndrome（RDS）.Methods Neonates admitted to neonatal department of Hebei province children hospital with RDS diagnosis and required respiratory support were randomly assigned to tracheal intubation mechanical ventilation group（synchronized intermittent positive pressure ventilation plus volume guarantee,SIPPV＋VG） and NIPPV group,and both groups would be treated with pulmonary surfactant（PS）.Parameters including FiO2,SaO2,PaO2,PaCO2,mean airway pressure（MAP） were monitored,and P/F（PaO2/FiO2）,a/APO2 were calculated at 0,12,24 and 72 hours.Complications and outcomes between the two groups were compared.Results Of the 44 patients,21 neonates were included in NIPPV group,and 23 in SIPPV＋VG group.The two groups were similar in gender,gestational age,birth weight,delivery mode,admission age,and PS injection time（P0.05）.Both groups had significant improvement of PaO2,FiO2,SaO2,P/F,a/APO2 and MAP at the time point of 12 h,24 h and 72 h than at 0 h（P0.001）,but at any time point there were no significant difference between the two groups.The incidence of ventilator associated pneumonia（VAP） and air leak in NIPPV group were much lower than SIPPV＋VG group（P0.05）;but there were no statistically significant differences in the incidence of pulmonary hemorrhage and intracranial hemorrhage（Ⅱ-Ⅳ）between the two groups（P0.05）.In NIPPV group,the hospital cost and ventilation time were much lower than SIPPV＋VG group,forthermore,oxygen exposure was significantly reduced in NIPPV group than SIPPV＋VG group（P0.05）.2 cases in NIPPV group（9.5%）needed mechanical ventilation because of deterioration hospital stay,efficacy and mortality rate were similar between the 2 groups（P0.05）.Conclusions As first choice of respiratory support in treating RDS,NIPPV could quickly improve ventil
出处
《中国新生儿科杂志》
CAS
2013年第1期12-16,共5页
Chinese Journal of Neonatology
基金
河北省医学适用跟踪项目(GL200902)
关键词
经鼻间歇正压通气
机械通气
呼吸窘迫综合征
新生儿
Nasal intermittent positive pressure ventilation
Mechanical ventilation
Respiratory distress syndrome, newborn
