双水平气道正压通气在早产儿轻度呼吸窘迫综合征的应用及对早期肺功能的影响

目的探讨双水平气道正压通气(BiPAP)治疗早产儿轻度呼吸窘迫综合征(RDS)的临床疗效及对患儿早期肺功能的影响,为BiPAP应用于早产儿轻度RDS的治疗提供临床参考。方法选择2016年6月-2018年1月安徽医科大学第三附属医院新生儿重症监护室(NICU)收治的76例早产儿轻度RDS为观察对象,生后即予无创呼吸支持,随机分为BiPAP组(38例)与持续气道正压通气(CPAP)组(38例),比较两组无创模式治疗早产儿RDS的治疗效果及对早期肺功能的影响情况。结果 1)与CPAP组比较,BiPAP组气管插管率明显降低(5.26%vs.26.32%,P<0.05),但平均无创通气时间、平均氧依赖时间、肺泡表面活性物质(PS)的重复应用、各种并发症的发生率、死亡率及平均住院时间的差异均无统计学意义(P>0.05);2)早期潮气肺功能参数中,与CPAP组比较,BiPAP组呼吸频率明显降低(42.98±4.26)次/min vs.(46.13±4.58)次/min]、潮气量明显升高(6.50±1.29)ml/kg vs.(5.55±1.03)ml/kg]、每分通气量明显增加(0.50±0.66)L/(min·kg)vs.(0.45±0.47)L/(min·kg)](P<0.05),而达峰时间比、达峰容积比、呼气峰流速及75%、50%、25%潮气量时呼气流速差异无统计学意义(P>0.05)。结论与CPAP相比,BiPAP治疗早产儿轻度RDS更加安全有效,同时可提高肺的顺应性,改善患儿早期肺功能。

Clinical trial and effect of Bi-level continuous positive airway pressure on early pulmonary function in preterm infants with mild respiratory distress syndrome

Objective To explore the efficacy and effect of Bi-level continuous positive airway pressure (BiPAP) on early pulmonary function in the treatment of premature infants with mild respiratory distress syndrome (RDS). Methods Totally 76 preterm infants with mild RDS in Neonatal Intensive Care Unit (NICU) of the Third Affiliated Hospital of Anhui Medical University were selected as participants from June 2016 to January 2018 and given non-invasive ventilation after birth. The infants were randomly divided into BiPAP group(38 cases) and CPAP group (38 cases). The therapeutic effect and early pulmonary function of the two groups were compared. Results 1) The endotracheal intubation rate of the BiPAP group was significantly lower than that of the CPAP group(5.26% vs. 26.32%, P<0.05),but the average duration for noninvasive respiratory support ,the average time of complementary oxygen need, repeated application of pulmonary surfactant, other complications, the death rate and the average hospitalization days between the two groups were not significantly different (P>0.05). 2) The BiPAP group had significantly lower respiratory rate(42.98±4.26)times/min vs. (46.13±4.58)times/min], higher tidal volume(6.50±1.29)ml/kg vs. (5.55±1.03)ml/kg] and minute ventilation (0.50±0.66)L/(min·kg) vs. (0.45±0.47)L/(min·kg)]( P<0.05), while the differences on the ratio of time to peak tidal expiratory flow to total expiratory time, ratio of volume to peak tidal expiratory flow to total expiratory volume, peak expiratory flow, and breathing flow at 75%, 50%, and 25% of tidal volume were not significant in both groups (P>0.05) . Conclusion Compared with CPAP, BiPAP is safer and more effective in the treatment of mild RDS in preterm infants, and can also improve lung compliance and early lung function in preterm infants with RDS.