nBiPAP与nCPAP治疗新生儿呼吸窘迫综合征的临床疗效及对患儿脑功能的影响

目的探讨两种无创正压通气在新生儿呼吸窘迫综合征(NRDS)初始治疗中的应用,及对其早期脑功能发育的影响。方法 2016年6月-2018年8月安徽医科大学第三附属医院NICU收治的符合入选标准的NRDS患儿50例,给予气管插管、使用肺表面活性物质、拔管,按照随机数字表法随机分为两组:nCPAP组(25例)与n Bi PAP组(25例)。根据TcSO2或血气分析调整FiO2等参数,记录各种临床指标。评估正压通气后24 h Tc SO2、血气参数及FiO2,应用aEEG评估脑成熟度。结果正压通气后24 h nBiPAP组FiO2(%)低于nCPAP组(P=0. 003),TcSO2(%)高于nCPAP组(P=0. 003);n BiPAP组aEEG得分明显高于n CPAP组,且a EEG各项评分与FiO2呈负相关(均P<0. 01),与TcSO2呈正相关(均P<0. 01)。结论在NRDS初始治疗中,nBiPAP组较nCPAP组更好地促进了肺氧合,减低了对FiO2的需求,改善了早产儿的早期脑功能。

The clinical effect on nBiPAP and nCPAP on neonatal respiratory distress syndrome and their effects on early cerebral functional development

Objective To explore the application of two non-invasive positive pressure ventilation modes has been chosen as the primary ventilation mode in neonatal respiratory distress syndrome( NRDS),and their effects on the development of the brain function. Methods From June 2016 to August 2018,50 neonates with NRDS who received intubation,pulmonary surfactant,extubation in NICU were randomly divided( by means of random number table) into two groups based on the primary mode of ventilation: n CPAP( n = 25) and nBiPAP( n = 25). Ventilation settings including FiO2 were adjusted according to transcutaneous saturation of oxygen( TcSO2) monitoring or blood gas analysis. The clinical indexes were recorded as well. The TcSO2,blood gas and FiO2 at 24 h post-positve-pressure ventilation were evaluated,amplitude integrated electroencephalogram( a EEG) were applied to evaluate brain maturity,including continuity,sleep-wake cycle,lower boundary amplitude,bandwidth and total scores. Results The FiO2( %) at 24 h post-ventilation in n Bi PAP group was lower than that in n CPAP group( P = 0. 003). The TcSO2( %) at 24 h post-ventilation in n Bi PAP group was higher than that in n CPAP group( P=0. 003). The brain maturity in n Bi PAP group was better than that in n CPAP group,and all scores of a EEG were correlated negatively with FiO2( all P<0. 01),and were correlated positively with TcSO2( all P<0. 01). Conclusion As the primary mode of ventilaton in NRDS,n Bi PAP is more beneficial than n CPAP in improving oxygenation and reducing the demanding for Fi O2,and improving the early brain function of the preterm infants.