经鼻间歇和持续正压通气治疗不同程度早产儿呼吸窘迫综合征的临床研究

目的观察经鼻间歇正压通气(NIPPV)和经鼻持续正压通气(NCPAP)治疗不同程度早产儿呼吸窘迫综合征(NRDS)的临床效果及安全性,为NRDS的临床治疗提供依据。方法选择2012年3月-2017年6月聊城市妇幼保健院收治的221例符合本研究标准的NRDS患儿,结合胸部X光片进行Ⅰ、Ⅱ、Ⅲ、Ⅳ级分级,随机分为NIPPV组和NCPAP组进行监护治疗,观察治疗有效率及并发症。结果Ⅱ、Ⅲ级患儿NIPPV组总有效率优于NCPAP组、应用肺表面活性物质(PS)例数、72h内气管插管例数、严重呼吸暂停发生率明显少于NCPAP组,差异有统计学意义(P<0.05);NIPPV组和NCPAP组动脉导管未闭、颅内出血、气漏、支气管肺发育不良发生率比较差异无统计学意义;Ⅰ、Ⅳ级患儿两组疗效比较差异无统计学意义(P>0.05)。结论 NIPPV和NCPAP均可有效治疗Ⅰ级早产儿呼吸窘迫综合征,对Ⅱ、Ⅲ级患儿经鼻间歇正压通气治疗优于经鼻持续正压通气。对Ⅳ级患儿两组治疗有效率无显著差异。

Effects of nasal intermittent positive pressure ventilation compared with continuous positive airway pressure on preterm infants with different degrees of respiratory distress syndrome

Objective To compare the clinical effects of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) on the treatment of different degrees of neonatal respiratory distress syndrome (NRDS) in preterm infants,in order to provide evidence for clinical treatment of NRDS. Methods A randomized, controlled, single-center study was performed on 221 premature infants with NRDS in Liaocheng Women and Children Health Care Hospital from March 2012 to June 2017.And these premature infants were classified into Ⅰ,Ⅱ,Ⅲ,Ⅳ grades according to X-ray results, then randomly assigned to receive NIPPV and NCPAP.Effect and complications were compared between the two groups. Results The effective rates of Ⅱ,Ⅲ grades in NIPPV group were higher than those in NCPAP group(P＜0.05).The proportion of pulmonary surfactant use, mechanical intubation, apnea in the NIPPV group among Ⅱ,Ⅲ grades was significantly lower than those in NCPAP group(P＜0.05).However, no significant differences were found on the incidence of patent ductus arteriosus, intracranial hemorrhage,air leak syndrome between the two groups.There was no significant difference on therapeutic effect of NRDS children among Ⅰ,Ⅱ grades(P>0.05). Conclusions As an initial respiratory support for the treatment of NRDS preterm infants, NIPPV has similar efficacy with in the treatment of I-grade NRDS.In terms of Ⅱ and Ⅲ grade of RDS, NIPPV has an advantage over NCPAP.Neither NIPPV nor NCPAP is effective for Ⅳ grade of NRDS.