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目的探讨经鼻间歇正压通气(NIPPV)治疗早产儿呼吸窘迫综合征(RDS)的疗效及安全性。方法将2010年1-12月本院收治的胎龄小于34周RDS早产儿30例设为NIPPV组,并将2009年3月-2010年11月随机抽取的胎龄小于34周RDS早产儿30例作为经鼻持续正压通气(NCPAP)组,2组患儿胎龄、出生体质量比较差异均无统计学意义。诊断RDSⅢ～Ⅳ级,无严重并发症,均接受肺表面活性物质治疗。结果 NIPPV组辅助通气时间较NCPAP组明显缩短(P<0.05)。机械通气率NIPPV组明显低于NCPAP组,且病死率及肺气漏无增加。2 h时,2组呼吸机工作参数比较无统计学差异(P>0.05),12 h、24 h和36 h时比较差异均有统计学意义(Pa<0.05),12 h、24 h和36 h时吸氧体积分数比较差异均有统计学意义(Pa<0.05)。呼气末正压12 h、24 h和36 h时比较差异均有统计学意义(Pa<0.05)。2组2 h时pH比较无统计学差异(P>0.05),而12 h、24 h和36 h时pH的差异均有统计学意义。12 h时动脉血氧分压比较无统计学差异(P>0.05),而24 h和36 h均有统计学差异(Pa<0.05)。NIPPV组极低体质量儿及超极低出生体质量儿12例,NCPAP组10例,均未发生支气管肺发育不全。结论与NCPAP比较,NIPPV治疗RDS有较好疗效,且可减少RDS患儿的气管再插管和机械通气。
Objective To investigate the efficacy and safety of nasal intermittent positive pressure ventilation (NIPPV) in the treatment of respiratory distress syndrome (RDS) in preterm infants. Methods From January to December 2010, 30 preterm infants with gestational age less than 34 weeks in our hospital were enrolled as NIPPV group. From March 2009 to November 2010, 30 premature infants with gestational age less than 34 weeks Cases as nasal continuous positive pressure ventilation (NCPAP) group, two groups of children gestational age, birth weight difference was not statistically significant. RDS Ⅲ ~ Ⅳ grade diagnosis, no serious complications, are receiving pulmonary surfactant treatment. Results The time of assisted ventilation in NIPPV group was significantly shorter than that in NCPAP group (P <0.05). Mechanical ventilation rate was significantly lower in the NIPPV group than in the NCPAP group, with no increase in mortality and air leaks. There was no significant difference in the working parameters of ventilator between the two groups (P> 0.05) at 2 h, and at 12 h, 24 h and 36 h (P <0.05), 12 h, 24 h and 36 h when oxygen volume fraction differences were statistically significant (Pa <0.05). Positive end-expiratory pressure 12 h, 24 h and 36 h were significantly different (Pa <0.05). There was no significant difference in pH between the two groups at 2 h (P> 0.05), but the difference of pH at 12 h, 24 h and 36 h was statistically significant. There was no significant difference in arterial partial pressure of oxygen between 12 h and 24 h and 36 h (P <0.05). NIPPV group of very low birth weight children and ultra-low birth weight in 12 children, NCPAP group of 10 patients, all without bronchopulmonary dysplasia. Conclusions Compared with NCPAP, NIPPV has a good curative effect on RDS and can reduce tracheal re-intubation and mechanical ventilation in children with RDS.