空气鼻塞持续气道正压通气在早产儿机械通气撤机中的应用

目的探讨空气鼻塞持续气道正压通气(Nasal Continuous Positive Airway Pressure,NCPAP)对早产儿经气管插管机械通气拔管撤机后的呼吸支持。方法将37例胎龄<37 w、体重<25 000 g经气管插管机械通气的早产儿,拔管后随机分入空气NCPAP组(气源为空气)和头罩供氧组(气源为浓度35%～40%的氧气),过渡至正常自主呼吸。观察呼吸,监测经皮氧饱和度及动脉血气,比较两组撤机成功率和总用氧时间。结果空气NCPAP组16例:撤机失败4例,成功12例,成功率为75.0%,总用氧时间(87.51±16.73)h,撤机失败主要原因是低氧血症;头罩供氧组21例:撤机失败5例,成功16例,成功率76.2%,总用氧时间(116.35±19.24)h,撤机失败主要原因是呼吸暂停。两组撤机成功率比较差异无统计学意义(p>0.05),总用氧时间比较差异有统计学意义(p<0.05)。结论早产儿经气管插管机械通气拔管撤机后应用空气NCPAP过渡,与头罩供氧过渡撤机成功率基本一致,但可显著减少早产儿用氧。

AIR NASAL CONTINUOUS POSITIVE AIRWAY PRESSURE(NCPAP) IN PREMATURE INFANTS AFTER EXTUBATION

Objective Investigate the air nasal continouous postive airway pressure(NCPAP) respiratory support in premature infants after extubation.Methods 37 premature infants(<37 weeks gestation and 2 500 g birth weight)who were being mechanically ventilated were randomized after extubation to two groups: the air NCPAP(gas source was air) and the O2 via head box(gas source was oxygen of concentration from 35% to 40%)groups,and transitated to the normal breathing.Respiratory,monitored transcutaneous oxygen saturation and arterial blood gas analysis were observed,and then compare the extubation success rate and the total oxygen time between the two groups.Results The air NCPAP group 16 cases: failed in 4 cases,12 cases were successful,the successful rate were75.0%,The total oxygen time were(87.51± 16.73) h,Failure was mainly due to hypoxemia;the O2 via head box Group 21 cases: failed in 5 cases,16 cases were successful,the successful rate were 76.2%,And the total oxygen time were(116.35±19.24)h,Failure was mainly due to severe apnea.The extubation successful rate were no significant difference(p>0.05),but the total oxygen time were significant difference(p<0.05).Conclusion the air NCPAP used after extubation achieved basically the same extubation successful rate with the O2 via head box,but can be significantly reduced in preterm infants with oxygen.