面罩与鼻导管在极早产儿稳定期辅助通气中的应用效果比较

目的 比较面罩和鼻导管在极早产儿稳定期辅助通气中的应用效果.方法 接受辅助通气治疗的极早产儿80例,采用序贯入组的方法分为鼻导管组与面罩组,各40例.鼻导管组患儿出生后使用单侧鼻导管进行辅助通气,面罩组患儿出生后使用面罩进行辅助通气,采用呼吸监测仪对患儿的辅助通气压力峰值(PIP)、呼气末正压(PEEP)通气、潮气量、辅助通气呼吸次数、漏气量、大量漏气次数、气道阻塞次数进行测量,并记录出生后第1、5 分钟Apgar 评分、气管插管患儿数、住院期间死亡患儿数,出生第5 分钟心率和氧饱和度.结果 鼻导管组与面罩组患儿呼吸指标比较,PIP,PEEP,平均辅助通气呼吸次数,出生后第1、5 分钟Apgar评分,气管插管患儿数,住院期间患儿死亡率,出生后第1、5 分钟的心率与氧饱和度差异均无统计学意义(P>0.05);鼻导管组患儿平均大量漏气次数为425.11±20.92显著高于面罩组的321.67±17.26,平均漏气量百分比(30.58±9.26)%显著高于面罩组的(14.15±6.76)%,平均气道阻塞次数112.53±13.91显著高于面罩组的46.62±13.04,鼻导管组患儿的平均实际呼气潮气量为(4.62±2.40)mL·kg-1显著低于面罩组的(7.31±2.76)mL·kg-1,均差异有统计学意义(P<0.05).结论 采用面罩进行辅助通气比鼻导管能获得更好的辅助通气指标.其使用方法简单,易于掌握,值得在临床上推广.

Comparison of the effects of mask versus nasal tube for respiratory support of very preterm infants at birth

Objective To compare the effects of mask versus nasal tube for assisted ventilation of very preterm infants during the stabilization period.Methods Eighty cases of very preterm infants who underwent respiratory support therapy were assigned into mask group (n=40) and nasal tube group (n=40) by sequential method.Infants in nasal tube group received respiratory support by nasal tube while infants in mask group received respiratory support by mask.The PIP,PEEP,tidal volume,respiratory rates,air lakage,high leakage rates,and airway obstruction rates were measured and recorded by respiratory function monitor.Apgar scores 1 min and 5 min after birth,number of infants with tracheal intubation,infants' mortality,and heart rate and SpO2 at 5 min after birth were recorded.Results There were no significant differences between mask group and nasal tube group in PIP,PEEP,average respiratory rates,Apgar scores at 1 min and 5 min after birth,number of infants with tracheal intubation,infants' mortality,heart rate and SpO2 at 1 min and 5 min after birth (P>0.05).The mean frequency of air leakage,percentage of mean air leakage and mean frequency of obstraction in nasal tube group were significantly higher than those in mask tube [425.11±20.92 vs 321.67±17.26,(30.58±9.26)% vs (14.15±6.76)%,112.53±13.91 vs 46.62±13.04].The mean expiratory tidal volume of infants in nasal tube group was significantly lower than that in mask group [(4.62±2.40)mL·kg-1 vs (7.31±2.76)mL·kg-1,P<0.05].