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目的比较呼吸窘迫综合征(RDS)早产儿早期使用双水平正压通气(DuoPAP)和持续呼吸道正压通气(NCPAP)模式是否可以降低插管有创呼吸支持率和支气管肺发育不良(BPD)的发病率。方法本试验为单中心、随机对照研究,将胎龄30～34+6周出生6 h内的RDS早产儿随机分为早期使用DuoPAP组和早期使用NCPAP组,若这2种方式不能维持患儿生命体征则使用气管内插管,并使用肺表面活性物质气管内滴入,接呼吸机辅助呼吸,模式选择为同步间歇指令通气模式和辅助/控制模式。主要观察指标为出生24 h、48 h、72 h总插管有创呼吸支持率及BPD发病率,次要观察指标为使用无创呼吸机支持总时间、有创呼吸机使用时间、总用氧时间、气胸发病率、坏死性小肠结肠炎发病率、脑室内出血发病率(Ⅲ级以上)、全肠道喂养时间、总住院时间。结果入组的67例早产儿随机分为早期DuoPAP组(34例)和早期NCPAP组(33例),2组早产儿出生24 h总插管有创呼吸支持率比较差异无统计学意义(P=0.074),DuoPAP组48 h、72 h总插管有创呼吸支持率明显低于NCPAP组(P=0.030、0.033),但2组BPD发病率比较差异无统计学意义(P=0.979)。2组间次要观察指标比较差异均无统计学意义。结论早期使用DuoPAP可明显降低RDS患儿出生24 h后总插管有创呼吸支持率,但不能降低BPD发病率。
Objectives To compare whether DuoPAP and NCPAP early in preterm infants with respiratory distress syndrome (RDS) can reduce intubated invasive respiratory support and bronchopulmonary dysplasia (BPD) Incidence. Methods This trial was a single-center, randomized controlled study. Preterm infants with RDS within 6 h of gestational age ranging from 30 to 34 + 6 weeks were randomly divided into two groups: early use of DuoPAP and early use of NCPAP. The vital signs were endotracheal intubation and intratracheal instillation of pulmonary surfactant followed by ventilator assisted breathing. The mode selection was synchronized intermittent mandatory ventilation and assisted / controlled mode. MAIN OUTCOME MEASURES: Invasive respiratory support rate and BPD incidence rate of total intubation at 24 h, 48 h, and 72 h after birth were measured. The secondary observation indexes were the total duration of non-invasive ventilator support, invasive ventilator use time, total oxygen use time , Incidence of pneumothorax, incidence of necrotizing enterocolitis, incidence of intraventricular hemorrhage (grade III or above), total gut feeding time, total length of stay. Results A total of 67 preterm infants were randomly divided into early DuoPAP group (n = 34) and early NCPAP group (n = 33). There was no significant difference in invasive respiration rate between two groups = 0.074). The invasive rate of intubation in DuoPAP group at 48 h and 72 h was significantly lower than that in NCPAP group (P = 0.030,0.033). However, there was no significant difference in the incidence of BPD between two groups (P = 0.979). There was no significant difference between the two groups in secondary observation index. Conclusion Early use of DuoPAP can significantly reduce the total invasive intubation support rate of RNC children 24 h after birth, but can not reduce the incidence of BPD.