NIPPV和NCPAP作为早产儿拔管后无创呼吸支持模式的临床应用疗效对比

目的 探讨经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)作为早产儿气管插管拔管后无创呼吸支持模式的临床应用疗效对比。方法 选取2016年1月～2017年6月在我院治疗的新生儿呼吸窘迫综合征65例,采用随机数字表法将患儿随机分为NIPPV组(n=32)和NCPAP组(n=33),观察两组撤机失败率、无创呼吸支持时间、无创后吸氧时间及总用氧时间,同时检测治疗前后二氧化碳分压(PaCO_2)、氧分压(PaO_2)和氧合指数(OI),两组并发症的发生情况。结果 NIPPV组和NCPAP组撤机失败率、无创后吸氧时间和总用氧时间比较,差异无统计学意义(P0.05);NIPPV组无创呼吸支持时间为2(1,3)d,明显短于NCPAP组(P0.05);NIPPV组和NCPAP组治疗前后PaO_2、PaCO_2比较,差异无统计学意义(P0.05);NIPPV组治疗后12 h、24 h OI分别为(240.100±31.140)%和(260.040±38.890)%,明显高于NCPAP组(P0.05);NIPPV组和NCPAP组支气管肺发育不良、早产儿视网膜病、新生儿坏死性小肠结肠炎和总发生率的比较,差异无统计学意义(P0.05)。结论 相比较NCPAP,早产儿气管插管拔管后应用NIPPV可缩短无创呼吸支持时间,值得临床使用。

Efficacy comparison of clinical application of NIPPV and NCPAP as a noninvasive respiratory support model for preterm infants after extubation

Objective To compare the clinical efficacy between nasal intermittent positive pressure ventilation(NIPPV)and continuous nasal continuous positive airway pressure (NCPAP) as a noninvasive respiratory support model after tracheal intubation in preterm infants.Methods A total of 65 neonates with respiratory distress syndrome treated in our hospital from January 2016 to June 2017 were selected.The children were randomly divided into NIPPV group(n=32)and NCPAP group(n=33) by random number table method.The machine withdrawal failure rate,noninvasive respiratory support time,oxygen inhalation time after noninvasive mechanical ventilation and the total oxygen time between the two groups were observed.At the same time,the carbon dioxide partial pressure(PaCO2),oxygen partial pressure(PaO2) and oxygenation index(OI) before and after treatment,and the occurrence of complications in the two groups was detected.Results There was no statistically significant difference in the machine withdrawal failure rate,oxygen inhalation time after noninvasive mechanical ventilation and total oxygen time between the NIPPV group and the NCPAP group(P>0.05).The noninvasive respiratory support time in the NIPPV group was 2(1,3)days,which was significantly shorter than that in the NCPAP group (P<0.05).There was no significant difference in PaO2 and PaCO2 between the NIPPV group and the NCPAP group before and after treatment(P>0.05).The OI at the 12 h and 24 h after treatment in the NIPPV group was (240.100±31.140)% and (260.040±38.890)%,significantly higher than that in the NCPAP group(P<0.05).There were no statistically significant differences in bronchopulmonary dysplasia,retinopathy of premature infants,neonatal necrotizing enterocolitis and total incidence between the NIPPV group and the NCPAP group(P>0.05).Conclusion Compared with NCPAP,the application of NIPPV after tracheal extubation in preterm infants can shorten the noninvasive respiratory support time and is worthy of clinical use.