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目的评价鼻塞式双水平正压通气(Duo PAP)、鼻塞式持续气道正压通气(NCPAP)在早产儿呼吸窘迫综合征(RDS)早期治疗中的临床疗效。方法 NICU住院RDS早产儿82例,采用气管插管-肺表面活性物质(PS)-拔管(INSURE)策略后,分为Duo PAP组(42例)及NCPAP组(40例),比较两组呼吸支持后氧合指数(OI)、二氧化碳分压(PaCO_2)、氧分压(PaO_2)、吸入氧浓度(FiO_2),有创呼吸及总有创呼吸支持率,无创呼吸支持总时间,总用氧时间,支气管肺发育不良(BPD)、早产儿视网膜病变(ROP)、脑室内出血(IVH)的发病率等。结果与NCPAP组相比Duo PAP组正压通气后1、12、24 h PaCO_2均较低,OI较高,PaO_2较高;FiO_2在12、24 h均低,其他时间组间差异均无统计学意义(P>0.05);Duo PAP组在24、48、72 h内总有创呼吸支持率低于NCPAP组(P<0.05);两组无创呼吸支持时间、总用氧时间、并发症发病率、总住院时间比较,差异均无统计学意义(P>0.05)。结论早产儿RDS早期治疗采用Duo PAP模式在提高氧合,减少CO_2潴留方面优于NCPAP模式,未增加并发症。
Objective To evaluate the clinical efficacy of nasal double positive pressure ventilation (Duo PAP) and nasal continuous positive airway pressure (NCPAP) in the early treatment of premature infants with respiratory distress syndrome (RDS). METHODS: Eighty-two preterm infants with NICD were enrolled in this study. They were divided into Duo PAP group (n = 42) and NCPAP group (n = 40) by tracheal intubation-pulmonary surfactant (PS) Respiratory support oxygen index (OI), partial pressure of carbon dioxide (PaCO_2), partial pressure of oxygen (PaO_2), inspired oxygen concentration (FiO_2), invasive breathing and total invasive respiratory support, noninvasive respiratory support total time, Oxygen time, bronchopulmonary dysplasia (BPD), retinopathy of prematurity (ROP), and incidence of intraventricular hemorrhage (IVH). Results Compared with NCPAP group, Duo PAP group had lower PaCO_2, higher OI and higher PaO 2 1, 12 and 24 h after positive pressure ventilation, FiO 2 was lower at 12 and 24 h, and there was no significant difference in other time groups (P> 0.05). The total invasive respiration rate in Duo PAP group was lower than that in NCPAP group (P <0.05) within 24,48,72 h. The duration of noninvasive respiration support, total duration of use of oxygen and morbidity of complication , Total hospital stay, the difference was not statistically significant (P> 0.05). Conclusions The early treatment of RDS in preterm infants with Duo PAP mode is superior to NCPAP in improving oxygenation and reducing CO2 retention without increasing the complications.