双水平气道正压通气与经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征疗效比较被引量：14

Comparison of the curative effect of bi - level positive airway pressure and nasal continuous positive airway pressure in the treatment of neonatal respiratory distress syndrome

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摘要目的比较双水平气道正压通气（BiPAP）与经鼻持续气道正压通气（CPAP）在早产儿新生儿呼吸窘迫综合征（RDS）中的临床应用效果。方法采用数字表法随机将64例RDS早产儿分为BiPAP组（n=35）和CPAP组（n=29），比较两组无创通气上机前、2h、12h血气分析，呼吸机累计时间，住院时间，并发症的发生情况，包括腹胀、胃食管反流、支气管肺发育不良（BPD）、脑室内出血（IVH）、呼吸机相关性肺炎（VAP）发生率。结果BiPAP组应用2h、12h后pH、Pa02均优于CPAP组（t=2．391、2．556、2403、2．355，P=0．020、0．013、0．019、0．022），低氧血症、停机后呼吸暂停、12h后改有创机械通气、呼吸机累计时间、住院时间均低于CPAP组（t=5．049、4．988、4．215、-2．096、-2．669，P=0．025、0．026、0．040、0．041、0.010）。结论早期使用BiPAP与NCPAP相比，可明显降低RDS患儿插管有创呼吸支持率，值得推广。 Objective To compare the clinical application effect of bi - level positive airway pressure （BiPAP） and nasal continuous positive airway pressure （CPAP） in the treatment of preterm infants with neonatal respiratory distress syndrome （NRDS）. Methods 64 neonates with NRDS were divided into the BiPAP group （n = 35 ） and NCPAP group （ n = 29） according to the randomized controlled study method. The blood gas index before and after 2,12 hours of treatment, the total time for ventilation, length of stay, and the incidence rate of abdominal disten-sion, gastroesophageal reflux, bronchopulmonary dysplasia, intraventricular hemorrhage, ventilator - associated pneumonia in the two groups were compared. Results The levels of pH and PaO2 in the BiPAP group were higher than those in the NCPAP group in noninvasive respiratory support for 2,12 h （ t = 2.391,2. 556,2403,2. 355, P = 0.020,0.013, 0.019,0. 022）. The incidence rates of hypoxemia, apnea, re -intubation mechanical ventilation rate after 12h in the BiPAP group were lower than those in the NCPAP group （t = 5. 049,4. 988,4.215, P = 0.025,0. 026, 0.040）. The length of stay and mechanical ventilation time in the BiPAP group were shorter than those in the NCPAP group（t = - 2.096, - 2.669,P = 0.041,0. 010）. Conclusion Compared with NCPAP, early application of BiPAP can obviously reduce the invasive respiratory support rate of children with NRDS with intubation. It is worthy of promotion.

作者范宜佳陈桂锋滕懿群

机构地区嘉兴市第二医院儿科浙江省嘉善县第一人民医院儿科

出处《中国基层医药》 CAS 2016年第6期822-825,共4页 Chinese Journal of Primary Medicine and Pharmacy

基金浙江省适宜技术成果转化计划（20122HB021）

关键词呼吸窘迫综合征通气人工婴儿新生 Respiratory distress syndrome Ventilation,artificial Infant,newborn

分类号 R722.1 [医药卫生—儿科]

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参考文献14

1Sai Sunil K ishore M, Dutta S, Kumar P. Early nasal intermittent posit ire pressure ventilation versus continuous positive airway pressure for regpiratory distress syndrome [ J ]. Acta Paedar,2009, 98(9) :1412-1415.
2Sweet DG,Carnielli V, Greisen G,et al. European Consensus Guide- lines on the Management of Neonatal Respiratory Distress Syndrome in Preterm Infants-2013 Update [ J ]. Neonatology, 2013,103 (4) :353- 368.
3Sweet D, Bevilacqua G, Carnielli V, et al. European consensus guidelines on the management of neonatal respiratory distress syn- drome[J]. J Perinat Med ,2007,35 : 175-186.
4高翔羽,杨波,黑明燕,崔湘君,王静,周广玲,渠慎英.三种无创正压通气在早产儿呼吸窘迫综合征初始治疗中应用的随机对照研究[J].中华儿科杂志,2014,52(1):34-40. 被引量：68
5Hutchison AA, Bignall S. Non-invasive positive pressure ventila- tion in the preterm neonate:reducing endotrauma and the inci- dence of brenchopulmonary dysplasia [ J ]. Arch Dis Child Fetal Neonatal Ed,2008,93( 1 ) : F64-F68.
6All N. Effeots of non-invasive pressure support ventilation ( NI- PSV) on ventilation and respiratory effort in very low birth weight infants[J]. Pedatr Pulmonol,2007,42(8) :704-710.
7Ancora G. Role of bilevel positive airway pressure in the manage- ment of preterm new-horns who have received suffactant[ J]. Acta Paediatr,2010, 99 (12): 1807-1811.
8Migliori C, Motta M, Angeli A, et al. Nasal bilevel vs. continuous positive airway pressure in preterm infants[ J]. Pediatr Pulmonol, 2005,40(4) :426-430.
9Victor S. A randomized controlled trial of nasal biphasie positive airway pressure vs. nasal continuous positive airway pressure fol- lowing extubation in infants less than 30 weeks gestation: study protocol for a randomized controlled trial [ J ]. Trials, 2011,12 (3) :257-264.
10Miall L, Wallis S. The management of respiratory distress in the moderately preterm new born infant[ J]. Arch Dis Child Educ Pr- acl Ed,2011,96 (4) : 128-135.

二级参考文献24

1Sweet DG, Carnielli V, Greisen G, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome in pretenn infants-2010 update[ J]. Neonatology, 2010, 97 : 402-417.
2Bhandm'i V. Nasal intermittent positive pressure ventilation in the newborn : review of literature and evidence-based guidelines[ J]. J Perinatol, 2010, 30: 505-512.
3O'Brien K, Campbell C, Brown L, et al. Infant flow biphasie nasal continuous positive airway pressure ( BP- NCPAP) vs. infant flow NCPAP for the facilitation of extubation in infants' < 1,250 grams: a randomized controlled trial[ J]. BMC Pediatr, 2012, 12: 43-51.
4Jackson JC. Respiratory distress in the preterm infant [ A ]// Gleason CA, Devaskar SU. Avery's diseases of the newborn. 9th ed. Philadelphia: Elsevier Saunders, 2012: 633-646.
5Lista G, Casoldi F, Fontana P, et al. Nasal CPAP versus bi-level nasal CPAP in prete,xn babies with respiratory distress syndrome : a randomised control trial[ J]. Arch Dis Child Fetal Neonatal Ed, 2010, 95: F85-F89.
6Richardson DK, Corcoran JD, Escobar GJ, et al. SNAP-II and SNAPPE-II: Simplified newborn illness severity and mortality risk scores[ J] J Pediatr, 2001, 138 : 92-100.
7Victor S. EXTUBATE: a randomised controlled trial of nasal biphasic positive airway pressure vs. nasal continuous positive airway pressure following extubation in infants less than 30 weeks' gestation: study protocol for a randomised controlled trial [ J ]. Trials, 2011, 12: 257-264.
8Sweet D, Bevilaequa G, Camielli V, et al. European consensus guidelines on the management of neonatal respiratory distress syndrome[J]. J Perinat Med, 2007, 35: 175-186.
9Stevens TP, Hanington EW, Blennow M, et al. Early suriactant administration with brief ventilation vs. selective surfactant and continued mechanical ventilation for preterm infants with or at risk for respiratory distress syndrome[ J/OL]. Cochrane Database Syst Rev, 2007, 4:CDO03063 (2007-10-17) [ 2013-05-01 ]. http:// onlinelibrary, wiley, com/doi/10. 1002/14651858. CD003063. pub 3/full.
10Rojas MA, Lozano JM, Rojas MX, et al. Very early surfaetant without mandatory ventilation in pmature infants treated with early continuous positive airway pressure : a randomized, controlled trial[J]. Pediatrics, 2009, 123: 137-142.