无创高频振荡通气与经鼻间歇正压通气作为早产儿拔管后呼吸支持疗效比较的Meta分析

目的 系统评估无创高频振荡通气(non-invasive high-frequency oscillatory ventilation,NHFOV)与经鼻间歇正压通气(nasal intermittent positive pressure ventilation,NIPPV)作为早产儿拔管后呼吸支持的有效性及安全性。方法 全面检索中国知网、万方数据库、中国期刊全文数据库、中国生物医学文献数据库、PubMed、Web of Science、Cochrane Library等数据库中关于NHFOV与NIPPV作为早产儿拔管后呼吸支持的文献,检索时间从建库至2022年8月31日。采用RevMan 5.4软件及Stata 17.0软件进行Meta分析,比较NHFOV组和NIPPV组拔管后72 h内再插管率、改无创辅助通气后6～24 h的二氧化碳分压(partial pressure of carbon dioxide,PCO₂)及支气管肺发育不良(bronchopulmonary dysplasia,BPD)、气漏、鼻损伤、脑室周围白质软化(periventricula...     

早产儿经鼻间歇正压通气的专家共识

经鼻间歇正压通气（nasal intermittent positive pressure ventilation,NIPPV）是在经鼻持续气道正压通气（nasal continuous positive airway pressure,n CPAP）的基础上给予间歇正压的一种呼吸支持模式,由于其具有避免气管插管等无创呼吸支持的优点,在早产儿领域的应用越来越多,已经成为早产儿的重要辅助通气方式[1,2]。     

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.     

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.     

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.     

Nasal continuous positive airway pressure versus nasal intermittent positive pressure ventilation for preterm neonates: a systematic review and meta-analysis

Aim: To determine whether nasal intermittent positive pressure ventilation (NIPPV) is more effective in preterm infants than nasal continuous positive airway pressure (NCPAP) in reducing the rate of extubation failure following mechanical ventilation, and reducing the frequency of apnoea of prematurity and subsequent need for endotracheal intubation. Methods: Randomized trials of NIPPV versus NCPAP were sought and their data extracted and analysed independently by the authors using the methodology of the Cochrane Collaboration. The analysis used relative risk (RR), risk difference (RD) and number needed to treat (NNT) with 95% confidence intervals. Results: The three studies identified, comparing NIPPV with NCPAP in the postextubation period, all used synchronized NIPPV (SNIPPV), which was more effective than NCPAP in preventing failure of extubation [RR 0.21 (0.10, 0.45), RD 30.32 (30.45, 30.20), NNT 3 (2, 5)]. Two studies compared NIPPV versus NCPAP for the treatment of apnoea of prematurity. Although meta-analysis was not possible one trial showed a reduction in apnoea frequency with NIPPV and the other a trend favouring NIPPV. Conclusion: SNIPPV is an effective method of augmenting the beneficial effects of NCPAP in preterm infants in the postextubation period. Further research is required to delineate the role of NIPPV in the management of apnoea of prematurity.     

系统评价胎龄小于32周早产儿预防性经鼻持续气道正压通气的作用

目的 评价早产儿早期应用经鼻持续气道正压通气（NCPAP）预防呼吸窘迫综合征（RDS）,减少呼吸机应用、病死率和并发症的发生。方法 以（prophylactic nasal CPAP OR early nasal CPAP）AND （preterm infants OR low birth weight infants） ,经鼻持续气道正压通气AND（早产儿OR低出生体重儿）为英中文关键词,检索PubMed、EMBASE、Cochrane临床对照试验库、维普中文科技期刊数据库、中国知网和万方数据库,检索时间均从建库至2011年12月,并辅以手工检索。应用RevMan 5.0软件进行Meta分析,根据异质性结果选择相应的效应模型分析;无法进行Meta分析时采用描述性分析。结果 8篇RCT文献进入分析。Meta分析结果显示： NCPAP组未能显著降低早产儿气管插管呼吸机应用率（RR＝-0.09,95%CI：-0.19~0.02,P=0.09）、RDS发生率（RR＝0.81,95%CI：0.59~1.1, P =0.18）和病死率（RR＝0.88,95%CI：0.72~1.09,P=0.25）;NCPAP组能显著减少早产儿肺表面活性物质应用率（RR＝0.72,95%CI：0.64~0.80,P﹤0.000 01）。NCPAP组未能显著减少气管插管呼吸机通气时间（MD= -1.91 d,95%CI：-6.47~4.45 d,P= 0.72）及氧气应用时间(MD=-0.46 d,95%CI：-6.55~5.63 d,P= 0.88）。NCPAP组除增加气胸的发生率外,并未明显增加支气管肺发育不良、颅内出血、早产儿视网膜病、败血症、新生儿坏死性小肠结肠炎和动脉导管未闭等并发症的发生率。结论 目前的证据表明早期应用NCPAP可减少肺表面活性物质应用,但增加了气胸的发生率;未能减少早产儿呼吸机应用、RDS发生率和病死率,未增加除气胸外的其他并发症发生率。     

经鼻间歇正压通气辅助呼吸治疗早产儿呼吸窘迫综合征

目的 探讨经鼻间歇正压通气(NIPPy)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.2h时,2组呼吸机工作参数比较无统计学差异(P＞0.05),12h、24h和36h时比较差异均有统计学意义(Pa＜0.05),12h、24h和36h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12h、24h和36h时比较差异均有统计学意义(Pa＜0.05).2组2h时pH比较无统计学差异(P＞0.05),而12h、24h和36h时pH的差异均有统计学意义.12h时动脉血氧分压比较无统计学差异(P＞0.05),而24h和36h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.     

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。     

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.     

双水平正压通气和持续气道正压通气在早产儿呼吸窘迫综合征中应用的比较

目的：对患有新生儿呼吸窘迫综合征（RDS）的早产儿早期使用双水平正压通气（DuoPAP）和经鼻持续气道正压通气（NCPAP）模式在降低有创呼吸支持率和支气管肺发育不良（BPD）发生率方面进行比较分析。方法：该试验为单中心随机对照试验,将胎龄30~35 周患有RDS生后6 h内的早产儿随机分为早期使用DuoPAP组（n=34）和早期使用 NCPAP组（n=33）,若这两种方式不能维持则使用气管内插管、呼吸机辅助呼吸,肺表面活性物质作为急救药物。观察患儿生后24 h、48 h及72 h内的总插管有创呼吸支持率、支气管肺发育不良（BPD）发生率及使用无创呼吸支持后1、12、24、48、72 h 二氧化碳分压（PaCO2）、氧分压（PaO2）及氧合指数（OI）。结果：DuoPAP组48 h内、72 h内总插管有创呼吸支持率明显低于NCPAP组（P0.05）。DuoPAP组OI无创呼吸支持后1、12、24、48、72 h均高于NCPAP组（均P<0.05）。DuoPAP组PaCO2在无创呼吸支持后1、12、24 h明显小于NCPAP组（P<0.05）;DuoPAP组PaO2在无创呼吸支持后1、12 h 明显大于NCPAP组（P<0.05）。结论：早期使用DuoPAP与NCPAP相比,可明显降低RDS患儿插管有创呼吸支持率,值得推广。     

两种不同通气模式在呼吸窘迫综合征早产儿撤机阶段的应用对比

目的 比较同步间歇指令通气（SIMV）与压力支持加容量保证通气（PSV+VG）两种模式在呼吸窘迫综合征（RDS）早产儿撤机阶段的应用效果。方法 选择2016年3月至2017年5月入住新生儿重症监护室、胎龄小于32周,且需要机械通气的40例RDS早产儿作为研究对象。40例患儿从进入撤机阶段开始被随机分为SIMV组和PSV+VG组,每组各20例。比较两组间呼吸机参数、动脉血气、撤机时间（从进入撤机阶段到拔管时间）、拔管后经鼻持续气道正压通气（NCPAP）使用时间以及拔管失败率;比较两组病死率及气胸、动脉导管未闭（PDA）、支气管肺发育不良（BPD）的发生率。结果 与SIMV组比较,PSV+VG组的平均气道压、撤机时间、撤机后NCPAP使用时间、拔管失败率均明显降低,差异有统计学意义（P < 0.05）。而两组在动脉血气、病死率及气胸、PDA、BPD发生率等方面的比较差异均无统计学意义（P > 0.05）。结论 在RDS早产儿撤机阶段,PSV+VG模式可能是一种相对安全有效的通气方式,但仍需要大样本、多中心的临床试验来证实。     

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。     

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.     

双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效和并发症Meta分析

目的 采用Meta分析的方法评价双水平正压通气(BiPAP）和经鼻持续气道正压通气（NCPAP）治疗早产儿呼吸窘迫综合征（RDS）的疗效和安全性。方法 计算机检索PubMed、Sciverse、Cochrane图书馆、中国知网、中国生物医学文献数据库、维普数据库及万方数据库,收集BiPAP和NCPAP治疗早产儿RDS的RCT文献。2名研究者根据纳入和排除标准独立筛选文献,应用RevMan 5.2软件进行Meta分析,比较BiPAP和NCPAP的治疗失败率、氧合情况和并发症发生率。结果 9篇RCT文献进入Meta分析,共纳入571例患儿,BiPAP 组289例,NCPAP组282例。Meta分析结果提示,BiPAP组治疗失败率低于NCPAP组,OR=0.42 （95%CI：0.20~0.89）,按出生体重行亚组分析,极低出生体重儿（出生体重<1 500 g）的1篇文献两组治疗失败率差异无统计学意义,OR=1.49(95%CI:0.51~4.33）;BiPAP组较NCPAP组显著提高呼吸支持后12 h和24 h PaO2 ,MD分别为6.88 mmHg（95%CI：4.38~9.38)和6.36 mmHg(95%CI：4.80~7.92);显著降低呼吸支持后12 h和24 h PaCO2,MD分别为-5.00 mmHg（95%CI：-5.75~-4.25)和-5.39 mmHg (95%CI:-6.18~-4.61);两组病死率差异无统计学意义,OR=0.76（95%CI:0.34~1.69）。支气管肺发育不良、新生儿坏死性小肠结肠炎、脑室内出血、气胸、早产儿视网膜病变等并发症发生率BiPAP和NCPAP组差异均无统计学意义。结论 BiPAP治疗早产儿RDS疗效优于NCPAP,且并发症发生率与NCPAP相当,但BiPAP治疗极低出生体重儿的疗效仍需积累更多证据。