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目的探讨双水平气道正压通气(Bi PAP)作为气管插管呼吸机撤离后过渡通气模式治疗早产儿呼吸窘迫综合征(RDS)的疗效。方法采用前瞻性病例随机对照方法,将胎龄<35周、需应用气管插管机械通气治疗的RDS早产儿,在符合拔管指征时,随机分为Bi PAP组和鼻塞持续气道正压通气(CPAP)组。比较两组患儿的血气分析变化、拔管失败率、呼吸机累计时间、住院时间、病死率及并发症发生率。结果 Bi PAP组33例,CPAP组32例,两组患儿基本情况和RDS分级、拔管时间等差异均无统计学意义(P>0.05)。无创通气3 h和12 h Bi PAP组PO2和动脉血氧饱和度(Sa O2)均高于CPAP组[3 h PO2:(63.5±3.7)mm Hg比(54.8±7.6)mm Hg,3 h Sa O2:(92.6±2.1)%比(88.4±2.2)%],PCO2低于CPAP组[3 h:(45.5±3.9)mm Hg比(55.0±3.4)mm Hg],差异有统计学意义(P<0.05)。拔管后,Bi PAP组低氧血症和高碳酸血症发生率及拔管失败率均低于CPAP组(9.0%比31.2%,12.1%比34.4%,9.0%比18.8%),差异有统计学意义(P<0.05)。Bi PAP组呼吸机累计时间和住院时间均短于CPAP组[(96.7±19.4)h比(118.5±30.1)h,(35.4±5.7)天比(42.7±6.1)天],差异有统计学意义(P<0.05)。结论 Bi PAP模式作为拔管后的过渡通气模式,治疗早产儿RDS比CPAP模式更有优势,可作为气管插管呼吸机撤除后的优先选择。
Objective To investigate the effect of bi-level positive airway pressure (Bi PAP) as a treatment of premature infants with respiratory distress syndrome (RDS) after the transitional ventilation mode of tracheal intubation with ventilator evacuation. Methods A prospective randomized controlled trial of preterm infants with gestational age less than 35 weeks who needed mechanical ventilation for endotracheal intubation was randomly divided into Bi PAP group and nasal continuous positive airway pressure Ventilation (CPAP) group. Blood gas analysis changes, extubation failure rate, ventilator cumulative time, hospital stay, mortality and complication rates were compared between the two groups. Results There were 33 cases in Bi PAP group and 32 cases in CPAP group. There was no significant difference in basic conditions, RDS classification and extubation time among the two groups (P> 0.05). PO2 and Sa O2 in Bi PAP group at 3 h and 12 h after noninvasive ventilation were higher than those in CPAP group [3 h PO2: (63.5 ± 3.7) mm Hg vs (54.8 ± 7.6) mm Hg, 3 h Sa (92.6 ± 2.1)% vs (88.4 ± 2.2)%], and the PCO2 was lower than that of the CPAP group [3 h: (45.5 ± 3.9) mm Hg vs (55.0 ± 3.4) mm Hg), with a statistically significant difference <0.05). After extubation, the incidences of hypoxemia and hypercapnia and extubation failure in Bi PAP group were lower than those in CPAP group (9.0% vs. 31.2%, 12.1% vs. 34.4%, 9.0% vs. 18.8%) Statistical significance (P <0.05). The cumulative time and length of hospital stay in Bi PAP group were shorter than those in CPAP group [(96.7 ± 19.4) h vs (118.5 ± 30.1) h and (35.4 ± 5.7) days vs (42.7 ± 6.1) days, respectively) (P <0.05). Conclusion As a transitional ventilation mode after extubation, Bi PAP model has more advantages than CPAP mode in the treatment of premature infants. It can be used as the preferred choice after the removal of endotracheal intubation ventilator.