摘要
目的探讨经鼻双水平气道正压通气(BIPAP)与连续气道正压通气(CPAP),在重度新生儿呼吸窘迫综合征(NRDS)早产儿撤机后的临床疗效。方法选择2014年1月至2016年1月,于山东大学齐鲁儿童医院住院治疗的75例重度NRDS早产儿(以下简称为受试儿)为研究对象。采用随机数字表法,将其分为BIPAP组(n=37)与CPAP组(n=38),分别于有创机械通气(MV)撤机后,采取经鼻BIPAP/CPAP治疗。对2组受试儿入院时一般临床资料,经鼻BIPAP/CPAP治疗疗效,采用成组t检验及χ^2检验进行统计学比较。本研究经病例收集医院医学伦理委员会批准(审批文号:ETYY-2020202),受试儿监护人均知情同意,并签署知情同意书。结果2组受试儿的研究结果如下。①一般临床资料比较:2组受试儿入院时年龄、胎龄、出生体重、生后1 min及5 min Apgar评分,NRDSⅢ/Ⅳ级及剖宫产术娩出受试儿所占比例,以及母亲有羊水浑浊、胎膜早破及产前使用激素病史的受试儿所占比例比较,差异均无统计学意义(P>0.05)。②BIPAP/CPAP疗效比较:BIPAP组受试儿撤机失败率、BIPAP治疗时间及撤机后2 d的动脉血二氧化碳分压(PaCO2)为13.5%、(5.0±0.6)d、(39.5±3.5)mmHg(1 mmHg=0.133 kPa),均显著低于或少于CPAP组的34.2%、(6.4±1.0)d、(54.8±4.3)mmHg,并且差异均有统计学意义(χ^2=4.402、P=0.035,t=2.970、P=0.019,t=16.873、P<0.001);BIPAP组受试儿撤机即刻及撤机后2 d的动脉血氧分压(PaO2)为(65.4±5.8)mmHg、(83.0±6.9)mmHg,均显著高于CPAP组的(54.4±8.1)mmHg、(80.2±4.0)mmHg,并且差异均有统计学意义(t=6.715、P<0.001,t=2.157、P=0.017)。③短期预后指标比较:BIPAP组受试儿呼吸暂停/心动过缓发生率为16.2%,显著低于CPAP组的39.5%,并且差异有统计学意义(χ^2=5.029,P=0.024)。2组受试儿住院时间,腹胀/鼻中隔损伤、支气管肺发育不良(BPD)、新生儿坏死性小肠结肠炎(NEC)、早产儿视网膜病(ROP)及脑室内出血(IVH)发生率,以及死亡率比较,差异均无统计学意义(P>0.05)。结论有创MV撤机后,采取BIPAP,将有助于重度NRDS早产儿撤机成功,是有效的肺保护策略。
Objective To investigate the clinical curative effect of nasal bi level positive airway pressure(BIPAP)and continuous positive airway pressure(CPAP)after extubation of premature neonates with severe neonatal respiratory distress syndrome(NRDS).Methods From January 2014 to January 2016,a total of 75 cases of severe NRDS premature neonates(hereinafter referred to as subjects)who were hospitalized in Qilu Children′s Hospital of Shandong University,were selected as research subjects.They were divided into BIPAP group(n=37)and CPAP group(n=38)by random digits table method.After extubation of invasive mechanical ventilation(MV),they took measures of nasal BIPAP/CPAP for noninvasive MV treatment.The general clinical data on admission,therapeutic effects of nasal BIPAP/CPAP treatment between two groups were compared statistically by independent-samples t test and chi square test.This study was approved by the Medical Ethics Committee of case collection hospital(Approval No:ETYY-2020202).The guardians of the subjects all gave informed consents and signed the informed consents.Results Results were as follows.①Comparison of general clinical data:there were no significant differences between two groups of subjects in age on admission,gestational age,birth weight,Apgar scores of 1 min and 5 min after birth,the proportions of NRDSⅢ/Ⅳand subjects delivered by cesarean section,and the subjects proportions of mothers with turbid amniotic fluid,premature rupture of membranes and the history of prenatal use of hormones(P>0.05).②Comparison of efficacy variable of BIPAP/CPAP:the failure rate of extubation,duration of BIPAP treatment and the arterial partial pressure of carbon dioxide(PaCO2)2 days after extubation of subjects in BIPAP group were 13.5%,(5.0±0.6)d and(39.5±3.5)mmHg(1 mmHg=0.133 kPa),which were significantly lower or less than those of 34.2%,(6.4±1.0)d and(54.8±4.3)mmHg in CPAP group,and the differences were statistically significant(χ^2=4.402,P=0.035;t=2.970,P=0.019;t=16.873,P<0.001).Arterial partial pressure of oxygen(PaO2)immediately and 2 days after extubation of subjects in BIPAP group were(65.4±5.8)mmHg and(83.0±6.9)mmHg,which were significantly higher than those of(54.4±8.1)mmHg and(80.2±4.0)mmHg in CPAP group,and the differences were statistically significant(t=6.715,P<0.001;t=2.157,P=0.017).③Comparison of short-term prognostic indicators:the incidence of apnea/bradycardia of subjects in BIPAP group was 16.2%,which was significantly lower than that of 39.5%in CPAP group,and the difference was statistically significant(χ^2=5.029,P=0.024).There were no significant differences between two groups of subjects in hospitalization time,incidence of abdominal distension/nasal septal injury,bronchopulmonary dysplasia(BPD),neonatal necrotizing enterocolitis(NEC),retinopathy of prematurity(ROP)and intraventricular hemorrhage(IVH),as well as mortality(P>0.05).Conclusion Application of BIPAP after extubation,can help premature neonates with severe NRDS successful extubation,and it is an effective lung protection strategy.
作者
庄元华
王娜
李晓莺
刘建红
Zhuang Yuanhua;Wang Na;Li Xiaoying;Liu Jianhong(Department of Neonatology,Qilu Children′s Hospital of Shandong University,Jinan 250021,Shandong Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2020年第3期316-321,共6页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
济南市卫生计生委项目(2014-16)。
关键词
呼吸窘迫综合征
新生儿
通气机撤除法
拔管成功
连续气道正压通气
双水平气道持续正压通气婴儿
早产
Respiratory distress syndrome
newborn
Ventilator weaning
Successful extubation
Continuous positive airway pressure
Bilevel positive airway pressure
Infant
premature
