经鼻间歇正压通气防治早产儿呼吸窘迫综合征的临床研究

目的探讨经鼻间歇正压通气(NIPPV)在防治早产儿呼吸窘迫综合征(RDS)中的应用价值。方法选择2017年6月至2018年12月梧州市人民医院RDS早产儿90例,其中男性48例,女性42例;胎龄(29.03±0.58)周;出生体质量(996.91±98.52)g;病程(3.48±0.56)h;临床分级Ⅰ级58例,Ⅱ级32例;Apgar评分(6.85±1.06)分。依据随机数字表分为NIPPV组和持续气道正压通气(NCPAP)组,每组45例。NIPPV组给予NIPPV治疗,NCPAP组给予NCPAP治疗,若两组治疗后不能维持患儿生命体征则使用肺表面活性物质(PS)或行有创机械通气。结果NIPPV组和NCPAP组治疗12、24 h后和治疗结束时动脉血氧分压(PaO2)、氧合指数(OI)明显高于治疗前。NIPPV组治疗12、24 h后PaO2、OI明显高于NCPAP组,差异有统计学意义(P<0.05)。NIPPV组和NCPAP组治疗结束时PaO2、OI比较,差异无统计学意义(P>0.05);NIPPV组PS使用率(22.22%vs 44.44%)、有创通气率(17.78%vs 40.00%)、氧疗时间(71.42±7.62)h vs(85.62±9.24)h]、有创通气时间(46.78±5.32)h vs(55.27±6.14)h]、住院时间(30.42±3.65)d vs(35.62±3.89)d]、并发症率(31.11%vs 53.33%)明显低于NCPAP组,差异有统计学意义(P<0.05)。结论NIPPV可有效改善RDS早产儿通气功能,有利于减少PS使用、有创通气及并发症,值得临床推广。

Application value of nasal intermittent positive pressure ventilation for prevention and treatment of premature infants with respiratory distress syndrome

Objective To detect value of nasal intermittent positive pressure ventilation(NIPPV)for prevention and treatment of premature infants with respiratory distress syndrome(RDS).Methods From June 2017 to December 2018,a total of 90 premature infants with RDS were enrolled,which included 48 males and 42 females;gestational age was(29.03±0.58)weeks;birth body mass was(996.91±98.52)g;course of disease was(3.48±0.56)hours;clinical gradeⅠwas 58 cases and gradeⅡof 32 cases;Apgar score was(6.85±1.06)scores.According to random number table,all of them were divided into NIPPV group and continuous positive airway pressure(NCPAP)group,n=45.NIPPV group was treated with NIPPV and NCPAP group was treated with NCPAP,the pulmonary surfactant(PS)or invasive mechanical ventilation was used after vital signs of children cannot maintain vital signs of infants.Results The partial pressure of oxygen(PaO2)and oxygenation index(OI)of arteries at 12,24 hours after treatment and complete treatment in NIPPV group and NCPAP group were significantly higher than those of before treatment.The PaO2 and OI at 12,24 hours after treatment in NIPPV group were significantly higher than those in NCPAP group(P<0.05).There was no significant difference in PaO2 and OI between NIPPV group and NCPAP group at complete treatment(P>0.05).The PS utilization rate(22.22%vs 44.44%),invasive ventilation rate(17.78%vs 40.00%),oxygen therapy time(71.42±7.62)hours vs(85.62±9.24)hours],invasive ventilation time(46.78±5.32)hours vs(55.27±6.14)hours],hospitalization time(30.42±3.65)days vs(35.62±3.89)days]and complication rate(31.11%vs 53.33%)in NIPPV group were significantly lower than those in NCPAP group(P<0.05).Conclusion It is demonstrated that NIPPV could effectively improve ventilation function of premature infants with RDS,which is beneficial to reduce PS,invasive ventilation and complications,so is worth for further clinical promotion.