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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 the efficacy and safety of nasal intermittent positive pressure ventilation (NIPPV) and tracheal intubation with intermittent positive pressure ventilation (SIPPV) in the treatment of neonatal respiratory distress syndrome (RDS). Methods The children with neonatal RDS and respiratory support were selected and randomly divided into tracheal intubation mechanical ventilation group [SIPPV + volumetric assurance (VG) model] and NIPPV group. Both groups were given pulmonary surfactant (PS) alternative treatment. FiO2, SaO2, PaO2, PaCO2 and MAP were recorded at 0, 12, 24 and 72 h after respiration. P / F (PaO2 / FiO2), arterial / alveolar oxygen ratio (a / APO2), and comparisons were made between the two groups. Results There were 21 cases in NIPPV group and 23 cases in SIPPV + VG group. There was no significant difference in sex, gestational age, birth weight, mode of delivery, date of admission and PS time between the two groups (P> 0.05). There was no significant difference between the two groups in the indexes of 12, 24, 72hPaO2, FiO2, SaO2, P / F, a / APO2 and MAP (P <0.001) > 0.05). The incidence of ventilator-associated pneumonia (VAP) and air leak in the NIPPV group was lower than that in the SIPPV + VG group (P <0.05), but there was no significant difference in the incidence of pulmonary hemorrhage and intracranial hemorrhage (Ⅱ ~ Ⅳ) (P> 0.05). NIPPV group hospitalization costs, machine time were lower than SIPPV + VG group, and oxygen exposure time was significantly shorter (P <0.05). Two patients (9.5%) in the NIPPV group changed to mechanical endotracheal intubation due to further aggravation. There was no significant difference between the two groups in hospitalization days, cure rate and case fatality rate (P> 0.05). Conclusion NIPPV is the first choice of respiratory support for the treatment of RDS. It can rapidly improve the ventilation and oxygenation in children. Compared with mechanical ventilation of tracheal intubation, NIPPV can reduce the incidence of VAP and air leakage, reduce the oxygen exposure time and reduce the exposure time Time and hospital costs.