两种不同无创通气策略治疗新生儿呼吸窘迫综合征疗效分析

摘要：目的 比较经鼻间歇正压通气（NIPPV）联合经鼻持续正压通气（NCPAP）与单独NCPAP治疗新生儿呼吸 窘迫综合征（RDS）的临床疗效。方法 将2018年1月—2019年6月收治的102例RDS患儿随机分为NIPPV+NCPAP 组（50例）和NCPAP组（52例），比较应用NIPPV+NCPAP和NCPAP治疗RDS患儿后，2种方法在改善呼吸频率、改善 氧合、降低乳酸值、减少通气失败及相关并发症之间有无差异。根据通气结局将全体患儿分为通气失败组（34例）和 通气成功组（68例），分析2组患儿吸入氧体积分数（FiO2）及乳酸变化对通气结局的影响。结果 NIPPV+NCPAP组 通气支持1、6、12 h时，在降低呼吸频率、提高氧分压、改善氧合方面显著优于NCPAP组（均P＜0.05）；NIPPV+NCPAP 组血乳酸随通气时间呈下降趋势，通气12 h时，血乳酸显著低于NCPAP组（P＜0.05）；NIPPV+NCPAP组通气失败及 呼吸暂停比例显著低于NCPAP组（均P＜0.05）；而2组患儿无创通气时间、脱离无创后单独吸氧时间、达全肠道喂养 时间、住院时间、住院费用及因烦躁使用水合氯醛镇静次数、喂养不耐受、坏死性小肠结肠炎、败血症、动脉导管未 闭、颅内出血、支气管肺发育不良等并发症发生率差异均无统计学意义（均P＞0.05）。与通气成功组相比，通气失败 组患儿出生2 h内FiO2≥0.30及乳酸值持续升高者明显较多（均P＜0.05）。结论 应用NIPPV联合NCPAP无创通气 策略治疗新生儿呼吸窘迫综合征安全、有效，值得推广。

Efficacy analysis of two different noninvasive ventilation strategies in neonatal respiratory distress syndrome

Abstract：Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation combined with nasal continuous positive airway pressure (NIPPV+NCPAP) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome. Methods A total of 102 newborns with respiratory distress syndrome (RDS) who were admitted between January 2018 to June 2019 were randomly divided into two groups NIPPV+ NCPAP group (n=50) and NCPAP group (n=52). The differences in the improving respiratory rate, oxygen and reduce lactic acid value, ventilation failure, related complications were compared in newborns with RDS between NIPPV+NCPAP group and NCPAP group. According to the ventilation outcome, all the newborns were divided into failed ventilation group (n=34) and successful ventilation group (n=68). The effects of inhaled oxygen volume fraction (FiO2) and lactic acid on the outcome of ventilation were analyzed in the two groups. Results The reducing breath rate, increasing oxygen partial pressure and improving oxygen at 1 h, 6 h, and 12 h were significantly better in NIPPV+NCPAP group than those of NCPAP group (all P＜ 0.05). The lactic acid value decreased with ventilation time in NIPPV+NCPAP group. After ventilation for 12 h, the lactate value was significantly lower in NIPPV + NCPAP group than that of NCPAP group (P＜0.05). The ventilation failure and apnea also reduced in NIPPV+NCPAP group than those of NCPAP group (all P＜0.05). There were no significant differences in non-invasive ventilation time, no oxygenation time after non-invasive surgery, total intestinal feeding time, hospitalization time, hospitalization expenses, and complications such as chlorination of chloral hydrate due to irritability, feeding intolerance, necrotizing enterocolitis, sepsis, patent ductus arteriosus, intracranial hemorrhage, and bronchopulmonary dysplasia between the two groups of newborns (all P＞0.05). Compared with the successful ventilation group, the FiO2 ≥ 0.30 within 2 hours after birth and lactic acid value continued to increase obviously more in the ventilation failure group (all P＜ 0.05). Conclusion The noninvasive ventilation strategy with NIPPV combined with NCPAP is safe for neonatal respiratory distress syndrome, which is effective and worth promoting.