经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的随机对照研究

目的 比较经鼻间歇正压通气(NIPPV)与经鼻持续气道正压通气(NCPAP)在新生儿呼吸窘迫综合征(NRDS)中的疗效。方法 采用前瞻性研究方法,收集2011年3月至2012年5月符合入选标准的67例NRDS早产儿作为研究对象,随机分为NIPPV组和NCPAP组,分别实施NIPPV和NCPAP干预。比较两组患儿氧合指数(OI)、pH值、PaCO2、呼吸支持时间、并发症、成功率、住院病死率及支气管肺发育不良(BPD)发生率等指标。结果 实际纳入研究对象62例,其中NIPPV组32例,NCPAP组30例。在无创通气治疗后1 h,NIPPV组OI高于NCPAP组(P<0.05),而pH值和PaCO2在两组间差异无统计学意义(均P>0.05)。NIPPV组行气管插管机械通气(MVET)比例低于NCPAP组(P<0.05)。NIPPV组患儿治疗成功率高于NCPAP组(P<0.05),但两组呼吸支持时间差异无统计学意义(P>0.05)。 两组在气胸发生率、住院病死率及BPD发生率方面差异亦无统计学意义(均P>0.05)。结论 与NCPAP相比,NIPPV可显著降低NRDS早产儿行MVET比例。但尚不能证实NIPPV可显著降低NRDS早产儿住院病死率和BPD发生率。     

经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的疗效研究

目的 研究经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)在新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)中的疗效.方法 选择23例经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)治疗1～8 h后低氧血症、呼吸衰竭仍未改善的NRDS新生儿作为研究对象,比较由NCPAP改为NIPPV 1 h与8h后呼吸频率、心率、经皮氧饱和度(SpO2)、吸入氧浓度(FiO2)及血气分析指标的变化.结果 通气模式改为NIPPV后1h,患儿的呼吸频率、心率、FiO2明显降低,SpO2明显升高,差异均有统计学意义(t值分别为6.15、4.15、-5.31、5.73,P＜0.01).血气分析pH值、PaO2、PaCO2好转,差异均有统计学意义(P＜0.01),乳酸值改善不明显,模式改变前后检测值的差异无统计学意义(P＞0.05).但治疗后8h乳酸值明显好转,与改用NIPPV治疗前比较差异有统计学意义(P＜0.01).结论 在NRDS治疗中,NIPPV疗效优于NCPAP,并能避免或减少气管插管机械通气的应用.     

经鼻间歇正压通气治疗早产儿呼吸窘迫综合征疗效观察

目的探讨经鼻间歇正压通气(NIPPV)对新生儿呼吸窘迫综合征(RDS)的临床价值。方法选择本院新生儿重症监护病房2008年2月至2010年8月收住的RDS患儿,2009年5月之前的患儿应用肺表面活性物质(PS)后予以经鼻持续气道正压通气(NCPAP)治疗,之后的患儿应用PS后予以NIPPV,比较两组治疗成功率、血气变化、氧疗时间、并发症及住院费用。结果两组患儿基本情况和RDS分级差异无统计学意义(P均>0.05)。NIPPV组47例,治疗RDS成功率91.5%,明显高于NCPAP组的成功率73.3%,差异有统计学意义(P<0.05)。NIPPV组治疗后1 h的PaCO2比NCPAP组改善更明显,两组比较差异有统计学意义(P<0.05)。NIPPV组治疗后12 h的pH、PaCO2、PaO2优于NCPAP组[pH:(7.38±0.10)比(7.33±0.08),PaCO2:(32.5±8.9)mm Hg比(38.3±9.4)mm Hg,PaO2:(78.5±15.2)mm Hg比(70.4±13.2)mm Hg,P均<0.01]。NIPPV组氧疗时间短于NCPAP组,支气管肺发育不良发生率(12.8%)低于NCPAP组(33.3%),住院费用少于NCPAP组,差异有统计学意义(P<0.05)。结论 NIPPV治疗RDS疗效优于NCPAP。     

无创经鼻正压通气与常规正压通气治疗新生儿呼吸窘迫综合征的比较

目的探讨经鼻间歇正压通气(NIPPV)与气管插管同步间歇正压通气(SIPPV)治疗新生儿呼吸窘迫综合征(RDS)的疗效与安全性。方法选择本院新生儿科住院诊断为RDS且需要呼吸支持的患儿,随机分为气管插管机械通气组[SIPPV+容量保证(VG)模式]和NIPPV组,两组患儿均应用肺表面活性物质(PS)替代治疗。分别于呼吸支持0、12、24、72h记录吸入氧浓度(FiO2)、血氧饱和度(SaO2)、氧分压(PaO2)、二氧化碳分压(PaCO2)、平均气道压(MAP),计算P/F(PaO2/FiO2)、动脉/肺泡氧分压比值(a/APO2),并比较两组并发症及转归情况。结果 NIPPV组21例,SIPPV+VG组23例,两组患儿性别、胎龄、出生体重、分娩方式、入院日龄、应用PS时间差异均无统计学意义(P>0.05)。两组在12、24、72hPaO2、FiO2、SaO2、P/F、a/APO2、MAP均较0h显著改善(P<0.001),而两组之间各指标相比差异均无统计学意义(P>0.05)。NIPPV组呼吸机相关性肺炎(VAP)和气漏的发生率均低于SIPPV+VG组(P<0.05),肺出血、颅内出血(Ⅱ～Ⅳ级)的发生率差异无统计学意义(P>0.05)。NIPPV组住院费用、上机时间均低于SIPPV+VG组,且氧暴露时间明显缩短(P<0.05)。NIPPV组有2例(9.5%)患儿因病情进一步加重改为气管插管机械通气。两组患儿住院天数、治愈率及病死率差异均无统计学意义(P>0.05)。结论 NIPPV作为治疗RDS的首选呼吸支持模式,可以迅速改善患儿的通气和氧合,与气管插管机械通气相比,可以降低VAP和气漏的发生率,降低患儿氧暴露时间,减少上机时间及住院费用。     

经鼻间歇和持续气道正压通气治疗新生儿呼吸窘迫综合征的Meta分析

目的 评价经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的疗效.方法 检索PubMed、EMBASE、Ovid、Springer、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库,获得NIPPV与NCPAP治疗NRDS的相关RCT文献.根据随机分配方法,分配...     

经鼻间歇正压通气在初始治疗早产儿呼吸窘迫综合征中的临床应用

目的 探讨经鼻间歇正压通气（NIPPV）在初始治疗早产儿呼吸窘迫综合征（NRDS）中的临床有效性及安全性,探索NIPPV参数的初始设置。方法 采用随机对照研究方法,将100例NRDS早产儿随机分为NIPPV组（n=50）和经鼻持续气道正压通气（NCPAP）组（n=50）,比较采用NIPPV或NCPAP初始呼吸支持治疗NRDS时,在改善CO2潴留、改善氧合、减少再次气管插管率和再次使用肺表面活性物质（PS）率、减少有创呼吸支持时间,减少需氧时间以及并发肺气漏、腹胀、呼吸机相关性肺炎之间有无差异。结果 在给予无创呼吸支持1 h和6 h时,NIPPV组在减轻CO2潴留、改善氧合方面明显优于NCPAP组（P2>0.21时间（均PPP>0.05）。结论 初始即予NIPPV呼吸支持治疗早产儿NRDS,临床有效、安全,值得推广。     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

目的 评价经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)治疗早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)的临床疗效.方法 2008年1月至6月,检索PubMed、荷兰医学文摘(Embase)、OVID全文数据库、Cochrane图书馆、中国学术期刊网全文数据库(CNKI)、中国牛物医学文献数据库(CBMdisc),收集NIPPV治疗早产儿RDS的临床试验,进行质量分析,并对符合纳入标准的研究应用Revman4.2软件进行Meta分析.结果 纳入随机对照研究5篇,共284例RDS早产儿,其中在撤除气管插管呼吸机后阶段应用NIPPV与鼻塞持续正压通气(nasal continuous positive airway pressure,NCPAP)的疗效比较共3篇,Meta分析显示NIPPV组拔管失败率低于NCPAP组(8.34%vs 40.79%),差异有统计学意义[RR 0.21(95%CI:0.10～0.45;P<0.001)];3篇研究中2篇进行了支气管肺发育不良(bronchopulmonary dysplasia,BPD)的分析,Meta分析显示NIPPV组BPD患病率较低(39.34%vs 54.39%),但差异无统计学意义[RR 0.73(95%CI:0.49～1.07;P=0.11)];以NIPPV作为初始通气模式2篇,其中与气管插管常规通气(conventional ventilation,cv)模式比较1篇,NIPPV组比CV组BPD患病率低(10%vs 33.33%,P=0.04);与NCPAP比较1篇,NIPPV组比NCPAP组BPD患病率低(2.33%vs 17.07%,P=0.03).结论 NIPPV作为初始通气模式治疗早产儿RDS是可行的,NIPPV组具有较低的BPD患病率.在气管插管呼吸机拔管后阶段应用NIPPV可降低拔管失败率.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

早产儿呼吸窘迫综合征经鼻间歇正压通气治疗的Meta分析

Objective To agsess the efficacy of nasal intermittent positive pressure ventilation (NIPPV)in treatment of respiratory distress syndrome(RDS) in premature infants.Methods According to the requirements of Cochrane systematic review,a thorough literature search was performed among PubMed(1977-2008),Embase(1989-2008),OVID,Cochrane(2008),Chinese Digtal Hospital Library (www.chkd.cnki.net) and Chinese Biomedical Literature Disk Database(CBMdisc).Quality assessments of clinical trials were carried out Randomized controHed trials(RCTs)with NIPPV and RDS were enrolledand ReVnlan 4.2 software was used for meta-analysis.The trials were analyzed using relatire risk(RR) for dichotomous data,weighted mean difference(WMD) were used for continuous data,both kind of data were expressed by 95% confidence intervals(95%CI).For homogenous data(P≥0.10),fixed effects model was calculated,for heterogeneity data(P<0.10),random effects model was calculated.Results Five RCTs involving 284 premature infants diagnosed as respiratory distress syndrome(RDS) were included.Three studies comparing NIPPV with nasal continuous positive airway pressure(NCPAP) in the postextubation period,tHe extabation failure rate was 8.34%vs 40.79% in NIPPV group and NCPAP group,the NIPPV group had significantly lower extubation failure rates[RR 0.21(95%CI:0.10-0.45;P<0.001)].Two of the above.mentioned three studies analyzed bronchopulmonary dysplasia(BPD)rates,the incidence of BPD was 39.34%vs 54.39%in NIPPV group and NCPAP group,the NIPPV group had a trend towards lower BPD rates,but this did not reach statistical significance[RR 0.73(95%CI:0.49-1.07;P=0.11)].NIPPV was used as primary mode in two studies,one compared with conventional ventilation(CV),which detected that the NIPPV group had significantly lower BPD rates(10% vs.33.33%,P:0.04);the other compared with NCPAP,which also showed that NIPPV group had significantly lower BPD rates(2.33% vs.17.07%,P=0.03).Conclusion The primary mode NIPPV was found to be feasible as a method of ventilation in preterm infants with RDS,and Was associated with a decreased incidenee of BPD.In the postextubation period,NIPPV is more effective in preventing failure of extubation than NCPAP.     

应用同步鼻塞间歇正压通气进行序贯治疗早产儿呼吸窘迫综合征的疗效

目的 评价同步鼻塞间歇正压通气(SNIPPV)作为气管插管呼吸机撤离后的过渡通气模式,治疗早产儿呼吸窘迫综合征(RDS)的疗效.方法 采用单中心、随机对照研究,将胎龄＜35周、需应用气管插管机械通气治疗的早产儿67例,在符合拔管指征时,随机分为SNIPPV组(33例)及鼻塞持续正压通气(NCPAP)组(34例).比较2组患儿的血气分析、拔管失败率及并发症的患病率.结果 无创通气3h及12 h血气分析显示,SNIPPV组pa(O2)高于NCPAP组,pa(CO2)低于NCPAP组,2组比较差异均有统计学意义(P均＜0.05);拔管后,SNIPPV组低氧血症及高碳酸血症的发生率及拔管失败率均低于NCPAP组(P均＜0.05),呼吸暂停发作频率低于NCPAP组(P=0.000);与NCPAP组比较,SNIPPV组机械通气时间较短,氧疗时间较短,差异均有统计学意义(P均＜0.05).结论 SNIPPV作为拔管后的过渡通气模式,治疗早产儿RDS比NCPAP模式更有优势,可作为气管插管呼吸机撤除后的优先选择.     

Early nasal intermittent positive pressure ventilation versus continuous positive airway pressure for respiratory distress syndrome

Aim:  To determine whether early nasal intermittent positive pressure ventilation (NIPPV), in comparison to early continuous positive airway pressure (CPAP), can reduce the need for intubation and mechanical ventilation in preterm neonates with suspected respiratory distress syndrome (RDS).
Methods:  In this stratified open-label randomized controlled trial, neonates (28–34 weeks gestation) with respiratory distress within 6 h of birth and Downe's score ≥ 4 were eligible. Subjects were randomly allocated to 'early-NIPPV' or 'early-CPAP' after stratifying for gestation (28–30 weeks, 31–34 weeks) and surfactant use. Primary outcome was failure of the allocated mode within 48 h.
Results:  Seventy-six neonates were enrolled (37 in 'early-NIPPV' and 39 in 'early-CPAP' groups). Failure rate was less with 'early-NIPPV' versus 'early-CPAP'[13.5% vs. 35.9%, respectively, RR 0.38 (95% CI 0.15–0.89), p = 0.024]. Similarly, need for intubation and mechanical ventilation by 7 days (18.9% vs. 41%, p = 0.036) was less with NIPPV. Failure rate with NIPPV was less in the subgroups of subjects born at 28–30 weeks (p = 0.023) and who did not receive surfactant (p = 0.018).
Conclusion:  Among preterm infants with suspected RDS, early use of NIPPV reduces the need for intubation and mechanical ventilation compared to CPAP.     

无创通气在早产儿呼吸窘迫综合征中的应用进展

为了减少有创通气所带来的严重并发症,临床医生越来越多地在早产儿呼吸窘迫综合征(RDS)的初始治疗中采用无创通气(NIV)技术.在过去的40 年中,经鼻持续气道正压通气(NCPAP)一直是治疗RDS 的主要模式,甚至是唯一的NIV 模式.近十年来,随着传感器和人机连接界面的改进,产生了不少新的NIV 模式,如经鼻间歇正压通气(NIPPV)、双水平气道正压通气(BiPAP)等.随后的研究表明,有些新的模式在RDS 的治疗上可能较NCPAP 更为优越.为了让临床医生了解NIV 在早产儿RDS 初始治疗中应用的新进展,更好的运用NIV 技术,该文复习了近年来相关文献并作简要综述.     

经鼻同步间歇正压通气治疗早产儿呼吸暂停的临床研究

目的：比较经鼻同步间歇正压通气（NSIPPV）与经鼻持续气道正压通气（NCPAP）治疗早产儿呼吸暂停的疗效。方法：将2010年8月至2011年1月住院的80例呼吸暂停早产儿随机分为NSIPPV组与NCPAP组,每组40例,比较治疗前、治疗后2 h血气分析结果、上机时间、疗效和并发症。结果：治疗前两组血气分析结果的差异无统计学意义（P＞0.05）,治疗后2 h NSIPPV组的pH值、PaO2、PaCO2均明显优于NCPAP组（P＜0.05）;NSIPPV组上机时间（50±9 h）明显短于NCPAP组（91±11 h）,差异有统计学意义（P＜0.01）;两组治疗的总有效率（95% vs 85%）差异无统计学意义（P＞0.05）,但NSIPPV组3 d 内撤机的比例（23/40）明显高于NCPAP组（14/40）（P＜0.05）;两组并发症发生比率（22% vs 25%）差异无统计学意义（P＞0.05）。结论：NSIPPV治疗早产儿呼吸暂停比NCPAP更有优势。     

经鼻间歇正压通气治疗新生儿呼吸衰竭的随机对照研究

目的比较经鼻间歇正压通气(nIPPV)与经鼻持续气道正压通气（nCPAP）在新生儿呼吸衰竭中的疗效。方法采用RCT研究的方法,选择2008年1 ~12月在第三军医大学大坪医院NICU住院的呼吸衰竭新生儿作为研究对象,按随机数字表法将研究对象随机分为nIPPV组和nCPAP组,分别实施nIPPV 或nCPAP干预,观察患儿动脉血气分析、应用nIPPV和nCPAP时间、并发症和预后等指标,比较nIPPV组和nCPAP组治疗后需气管插管行机械通气的比例及其预后结局。结果研究期间nIPPV组纳入48例,nCPAP组纳入53例。两组在性别构成比、胎龄、年龄、出生体重、出生后5 min Apgar评分、新生儿急性生理学评分和应用肺表面活性物质比例等方面差异无统计学意义（P均>0.05）。两组呼吸衰竭原发病分布差异无统计学意义（P>0.05）。两组治疗前血气分析指标差异均无统计学意义（P均>0.05）,nIPPV组治疗后1 h血气分析pH和PaO2显著高于nCPAP组（P<0.05）。nIPPV组治疗成功率为77.1%(37/48例),nCPAP组为62.3%（33/53例）,nIPPV组显著高于nCPAP组（P<0.05）。nIPPV组和nCPAP组治疗成功的患儿平均应用nIPPV和nCPAP的时间差异无统计学意义（P均>0.05）。nIPPV组的预后结局中治愈和好转出院45/48例（93.8%）, nCPAP组为46/53例（86.8%）,两组差异无统计学意义（P>0.05）。结论与nCPAP相比,nIPPV治疗可显著降低呼吸衰竭新生儿气管插管行机械通气的比例。     

鼻塞式同步间歇指令通气和持续气道正压通气在早产儿呼吸窘迫综合征中的应用比较

目的：比较鼻塞式同步间歇指令通气(nSIMV)和鼻塞式持续气道正压通气（nCPAP）在早产儿呼吸窘迫综合征（RDS）中的临床应用效果。方法：50例RDS早产儿,常规使用肺表面活性物质进行替代治疗后,随机分入nSIMV组或nCPAP组,观察治疗后临床症状和血气指标的变化。结果：nSIMV组需气管插管行呼吸机通气比率明显低于nCPAP组（24% vs 60%, P<0.05）;nSIMV组CO2潴留和低氧血症的比率分别为12%和24%,明显低于nCPAP组的40%和36%（P<0.05）。结论：nSIMV能更有效地对RDS早产儿进行呼吸支持治疗。［中国当代儿科杂志,2010,12（7）：524-526］     

无创辅助通气联合氦氧混合气治疗早产儿呼吸窘迫综合征疗效和安全性的系统评价和Meta分析

目的系统评价无创通气(NIV)联合氦氧混合气(heliox)治疗早产儿呼吸窘迫综合征的有效性及安全性,以期为临床应用提供证据。方法计算机检索OVID、EMBASE、Pub Med、Cochrane图书馆、中国生物医学文献数据库、中国知网、维普中文科技期刊数据库及万方数据库,检索时间均为建库至2014年12月,纳入NIV联合heliox与NIV联合标准医疗气体(空氧混合气)为对照的RCT文献或半随机对照试验。以气管插管率、Pa CO2和heliox相关不良事件为主要结局指标,以支气管肺发育不良等并发症发生率、NIV持续时间、住院时间等为次要结局指标。采用Review Manager 5.2软件进行Meta分析。结果 3篇文献进入系统评价,共纳入123例早产儿。2篇文献随机化方法和分配隐藏为低度偏倚,3篇文献的结果数据均完整,均未选择性报告结果,但均未提及盲法实施。1与标准医疗气体比较,heliox显著降低了气管插管率(RR=0.42,95%CI:0.23~0.78)和Pa CO2水平(MD=-9.61 mm Hg,95%CI:-15.76~-3.45 mm Hg)。23篇文献均未观察到heliox相关的不良事件。3支气管肺发育不良、动脉导管未闭、早产儿视网膜病变和坏死性小肠结肠炎等并发症的发生率,两组差异均无统计学意义(P0.05)。结论与标准医疗气体相比,NIV联合heliox可显著改善通气,并降低气管插管率。鉴于本研究样本量有限,NIV联合heliox的临床价值尚需大样本RCT进行验证。     

经鼻同步间歇指令通气在重度呼吸窘迫综合征早产儿撤机后的应用

目的探讨重度呼吸窘迫综合征(RDS)早产儿撤机后行经鼻同步间歇指令通气(nSIMV)的临床疗效。方法回顾性分析2013年1月至2015年5月新生儿重症监护病房住院的126例RDS早产儿的临床资料。2013年1月至2014年3月住院患儿采用经鼻持续气道正压通气(nCPAP)(61例),而2014年4月至2015年5月住院患儿采用nSIMV(65例)。比较两组治疗后血气分析指标、撤机失败率与原因及并发症的差异。结果通气治疗4h后,nSIMV组pH值、氧分压(PaO_2)、血氧饱和度(SaO_2)和氧合指数(OI)均高于nCPAP组(均P0.05);nSIMV组二氧化碳分压(PaCO_2)低于nCPAP组(P0.05)。nSIMV组和nCPAP组撤机失败率分别是9%(6/65)和30%(18/61)(P0.05),其撤机失败的原因主要有低氧血症(2%vs 5%,P0.05)、高碳酸血症(6%vs 11%,P0.05)和呼吸暂停(2%vs 13%,P0.05)。两组患儿在呼吸机支持时间、全肠道喂养时间、恢复出生体重时间和总住院时间上比较差异无统计学意义(P0.05)。治疗后nSIMV组腹胀发生率明显低于nCPAP组(9%vs 30%,P0.05),但两组喂养不耐受、坏死性小肠结肠炎、脑室内出血、早产儿视网膜病变和支气管肺发育不良的发生率比较差异无统计学意义(P0.05)。结论重度RDS早产儿撤机后采用nSIMV不仅明显改善肺通气功能,降低撤机失败率,且治疗后胃肠道副反应小,不增加并发症的发生,在临床值得推广。