论文部分内容阅读
目的观察双水平正压通气(Bi PAP)和经鼻持续呼吸道正压通气(n CPAP)应用于早产儿呼吸窘迫综合征(RDS)初始治疗中的临床疗效及安全性。方法选取2014年1月至2015年1月早产儿重症监护病房收治的60例RDS患儿,给予“气管插管—使用肺表面活性物质(PS)—拔管”治疗后随机分为Bi PAP组和n CPAP组各30例。观察无创呼吸支持后1、12、24、48 h血气指标的变化;记录无创正压通气总时间及总住院时间、气漏综合征、支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)、Ⅲ度或Ⅳ度脑室内出血(IVH)、早产儿视网膜病(ROP)等相关并发症发生、死亡及无创呼吸支持后24、48、72 h内有创呼吸支持比例。结果 Bi PAP组1、12、24 h Pa CO2低于n CPAP组,1、12 h Pa O2及氧合指数(OI)均高于n CPAP组,差异均有统计学意义(P均<0.05)。两组总有创呼吸支持率及无创呼吸支持后24、48、72 h内有创呼吸支持率比较差异均无统计学意义(P均>0.05)。两组无创通气总时间、总住院时间及气漏综合征、BPD、NEC、Ⅲ度或Ⅳ度IVH、ROP、住院期间死亡率比较差异均无统计学意义(P均>0.05)。结论 Bi PAP应用于早产儿RDS的初始治疗,在提高氧合作用、减少CO2潴留方面优于n CPAP通气模式,且未增加并发症发生率,可作为RDS早产儿的首选通气模式。
Objective To observe the clinical efficacy and safety of bi-level positive airway pressure (PAP) and nasal continuous positive airway pressure (n CPAP) in the treatment of premature infants with respiratory distress syndrome (RDS). Methods Sixty children with RDS admitted to premature infants admitted to ICU from January 2014 to January 2015 were randomly divided into two groups according to “tracheal intubation - pulmonary surfactant (PS) - extubation” 30 cases in PAP group and n CPAP group. The changes of blood gas indexes were observed at 1, 12, 24 and 48 h after noninvasive respiratory support. The total duration of noninvasive positive pressure ventilation and total length of stay, air leak syndrome, bronchopulmonary dysplasia (BPD) and necrotizing enterocolitis ), III degree or IV IVH, ROP and other related complications, and the proportion of invasive respiratory support within 24, 48 and 72 h after death and noninvasive respiratory support. Results The PaCO 2 values in Bi PAP group were lower than those in n CPAP group at 1, 12 and 24 h (P <0.05), and PaO 2 and oxygenation index (OI) at 1, 12 and 12 h were higher than those in n CPAP group . There was no significant difference in invasive support rate between 24 h, 48 h and 72 h after both total invasive and non-invasive respiratory support (P> 0.05). The total duration of noninvasive ventilation, total length of hospital stay, and air leak syndrome, BPD, NEC, grade III or IV IVH, ROP and hospital stay mortality were not significantly different between the two groups (all P> 0.05). Conclusions Bi PAP is the first choice of ventilation for RDS in premature infants. It is superior to n CPAP ventilation in improving oxygenation and decreasing CO2 retention without increasing the incidence of complications.