摘要
目的 比较早期应用经鼻间歇正压通气（nasal intermittent positive pressure ventilation,NIPPV）与鼻塞式持续气道正压通气（nasal continuous positive airway pressure,NCPAP）治疗早产低出生体重儿呼吸窘迫综合征（respiratory distress syndrome,RDS）的效果.方法 本研究为前瞻性随机对照研究.研究对象为2010年1月至201 3年4月在广东省妇幼保健院住院的早产低出生体重RDS患儿383例,随机数字表法分为NIPPV组197例和NCPAP组186例.2组最终纳入分析的患儿分别为188和176例.2组患儿均在进入新生儿重症监护病房后开始无创辅助通气.治疗失败者立即行气管插管,改用同步间歇指令通气,并经气管应用肺表面活性物质.比较2组患儿气管插管率（治疗3d和7d内）和肺表面活性物质使用率、辅助通气时间、总用氧时间、并发症发生情况和死亡情况.采用t检验、Mann Whitney U检验和x2检验进行统计学分析. 结果 NIPPV组有创辅助通气时间明显短于NCPAP组[分别为2.0（1.0～4.0）d和7.0（3.0～8.5）d,U=-3.457,P=0.001].NIPPV组气管插管率（包括治疗3d和7d内）和肺表面活性物质使用率均低于NCPAP组,差异有统计学意义[3 d内插管率：4.8％ （9/188）与10.8％（19/176）,x2=4.621,P=0.032;7 d内累计插管率：9.0％（17/188）与16.5％（29/176）,x2=4.55l,P=0.033;肺表面活性物质使用率：3.2％（6/188）与8.5％（15/176）,x2=4.752,P=0.029].NIPPV组气漏、颅内出血、脑白质软化、早产儿视网膜病、坏死性小肠结肠炎、动脉导管未闭和支气管肺发育不良等并发症的发生率与NCPAP组比较,差异均无统计学意义（P值均＞0.05）.NIPPV组病死率为12.8％（24/188）,NCPAP组为10.8％（19/176）,2组差异无统计学意义（P＞0.05）.结论 NIPPV可明显减少早产RDS患儿行有创机械通气的比例,缩短有创通气时间,降低肺表面活性物质使用率,减少并发症,临床疗效优于NCPAP.
Objective To investigate the effects of early nasal intermittent positive pressure ventilation （NIPPV） compared with early continuous positive airway pressure （NCPAP） in low birth weight preterm infants with respiratory distress syndrome （RDS）.Methods We performed a prospective,randomized controlled trial involving 364 low birth weight preterm infants with respiratory distress syndrome within 6 hours of birth.The infants were randomly assigned to NIPPV （n=188） or NCPAP （n=176） groups.Non invasive ventilation was initiated in the neonatal intensive care unit （NICU）.The rate of mechanical intubation （within 3 days or 7 days）,the use of pulmonary surfactant （PS）,the rate of complications and mortality were compared between the two groups.Mann Whitney U,t and Chi-square tests were used for statistical analysis.Results The average time of invasive mechanical ventilation in NIPPV group were lower than that in NCPAP group[2.0 （1.0-4.0） d vs 7.0 （3.0-8.5） d,U=-3.457,P=0.001].The need for intubation and mechanical ventilation by day 3 and day 7 in the NIPPV group were less than those in the NCPAP group [day 3：4.8％ （9/188） vs 10.8％ （19/176）,x2=4.621,P=0.032; day 7：9.0％ （17/188） vs 16.5％ （29/176）,x2=4.551,P=0.033].In the NIPPV group,infants who got PS therapy was less than that in the NCPAP group [3.2％ （6/188） vs 8.5％ （15/176）,x2=4.752,P=0.029].There was no significant difference in the fatality rate between the NIPPV and the NCPAP group [12.8％ （24/188） vs 10.8％ （19/176）,P ＞ 0.05].There were no significant difference in the incidence of air leak,intracranial hemorrhage,periventricular leukomalacia,retinopathy of prematurity,necrotizing enterocolitis,patent ductus arteriosus,and bronchopulmonary dysplasia between the NIPPV group and the NCPAP group.Conclusion Among low birth weight prcterm infants with RDS,the early use of NIPPV reduces the need for PS,intubation and invasive ventilation compared with NCPAP.
出处
《中华围产医学杂志》
CAS
CSCD
2015年第2期111-116,共6页
Chinese Journal of Perinatal Medicine
基金
广东省医学科研项目（A2011076）
关键词
呼吸窘迫综合征
新生儿
间歇正压通气
连续气道正压通气
婴儿
出生时低体重
婴儿
早产
Respiratory distress syndrome,new born
Intermittent positive-prcssurc vcntilation
Continuous positive airway pressure
Infant,low birth weight
Infant premature
