经鼻持续气道正压通气在极低出生体质量儿呼吸支持中的应用价值

目的 评价经鼻持续气道正压通气(nCPAP)在极低出生体质量儿呼吸支持中的应用价值.方法 我院NICU从1999年1月至2008年12月共收治155例机械通气治疗的极低出生体质量儿,前5年只用有创通气,后5年采用无创通气、有创通气相结合的治疗方法.比较应用nCPAP前后5年通气策略改变后的治疗情况,包括平均通气时间、治愈率及并发症.结果 前5年机械通气53例,均为有创通气,平均通气时间(6.16±4.84)d.后5年机械通气102例:单纯ncPAP通气60例;有创通气结合nCPAP通气20例(10例在nCPAP治疗过程中病情有加重趋势,及时转为气管插管有创通气,10例在有创通气后改为nCPAP);单纯有创通气22例.平均有创通气时间(3.93±2.48)d,与前5年比较有下降,但差异无显著性(t=1.37,P＞0.05).前5年治愈率为27/53(50.9%),放弃治疗20例(37.7%),死亡6例(11.3%).后5年治愈率为85/102(83.3%),与前5年比较有明显上升,差异有非常显著性(x~2=18.25,P＜0.01);放弃治疗13例(12.8%),死亡4例(3.9%).应用nCPAP后,呼吸机相关性肺炎发生率有显著下降(x~2=6.08,P＜0.01),肺气漏、颅内出血及慢性肺部疾病的发生率无明显变化.结论 nCPAP是治疗极低出生体质量儿的一种安全有效的方法,可以减少有创通气的应用,降低呼吸机相关性肺炎发生率.

Application of nasal continuous positive airway pressure in very low birth weight infants with respiratory distress

Objective To evaluate the therapeutic effect of nasal continuous positive airway pressure (nCPAP) in very low birth weight infants( VLBWI) with respiratory distress. Methods One hundred and fifty-five VLBWI with respiratory distress needed mechanical ventilatory support were admitted to our NICU during 1999,1～2008,12. These infants were divided into two groups according to the admitted time. First group (admitted between 1999,1～2003,12) was treated with intermittent positive pressure ventilation (IPPV) only.Second group (admitted between 2004,1～2008,12) was treated with nCPAP only or IPPV + nCPAP or IPPV.The complications, survival rate and the average duration of IPPV of the two groups were compared. Results Fifty-three VLBWI were in the first group. The mean duration of IPPV was (6. 16 ±4. 84) d. One hundred and two VLBWI were in the second group, of which 60 patients received ventilation with nCPAP only,20 patients with IPPV + nCPAP.and 22 patients with IPPV. The mean duration of IPPV was (3. 93 ±2.48) d.Although the IPPV duration was decreased in the second group, but there was no statistically significant difference (f = 1. 37, P ＞ 0. 05). The ventilator-associated pneumonia rate of the second group was decreased (x~2 = 6.08, P ＜ 0.01), and the survival rate of the second group was increased compared with that of the first goup (x~2 = 18.25, P ＜ 0.01). Conclusion nCPAP is an effective and safe method for treating very low birth weight infants with respiratory distress. It can reduce the use of IPPV and decrease the rate of ventilatorassociated pneumonia.