鼻塞与鼻罩在无创通气治疗早产儿呼吸窘迫综合征中的效果

目的：了解鼻塞与鼻罩在无创通气治疗早产儿呼吸窘迫综合征（ RDS ）中的特点。方法选取2012年8月-2013年6月收治的符合入选标准的RDS早产儿，按照随机数字表法将患儿分为鼻塞组（48例）与鼻罩组（45例）。鼻塞组的无创通气连接界面选用短的双鼻塞，鼻罩组选用鼻罩。根据经皮血氧饱和度或血气分析调整FiO2等参数，记录各种参数及不良反应的发生率。结果鼻塞组无创正压通气后12～24 h血气分析的pH值为（7．32±0．06），PaCO2值为（48．2±9．0） mmHg，正压通气24 h时FiO2值为（0．39±0．08），腹胀3例，平均无创通气时间（54．1±16．8）h，无创通气失败12例；鼻罩组分别为（7．31±0．07），（47．2±10．2）mmHg，（0．38±0．08），5例，（54．8±13．6）h，9例，两组比较差异均无统计学意义（t/χ2值分别为0．169，0．484，0．464，0．217，-0．226，0．332；P＞0．05）。鼻塞组总脱落次数89次，总漏气次数352次，低于鼻罩组的48，489次，差异有统计学意义（χ2值分别为8．898，44．644；P＜0．05）。两组局部皮肤损伤发生率比较，差异无统计学意义（χ2＝0．009，P＞0．05），但皮肤损伤部位明显不同：鼻塞组皮肤损伤部位绝大部分在鼻中隔的内侧和鼻小柱，鼻罩组皮肤损伤部位绝大部分在鼻中隔与人中连接处及眉间。结论鼻塞较鼻罩更容易脱落，鼻罩比鼻塞更容易漏气，但这两种连接界面对无创通气时间及无创通气失败率等并无明显的影响。鼻塞和鼻罩导致鼻部损伤的发生率及程度基本相似，但损伤部位明显不同。

Effect of nasal prongs or nasal mask for non-invasive positive pressure ventilation in preterm infants with respiratory distress syndrome

Objective To understand the characteristics of nasal prongs or nasal mask for non-invasive positive pressure ventilation in preterm infants with respiratory distress syndrome （ RDS ） .Methods Ninety-three RDS preterm infants from August 2012 to June 2013 were chosen and divided into the nasal prong group （n=48） or nasal mask group （n=45） according to the random number table .The nasal prong group received the short binasal prongs as the connection interface , and the nasal mask group received the nasal mask .The parameters including fraction of inspiration O 2 （ FiO2 ） were adjusted according to transcutaneous oxygen saturation monitoring or blood gas analysis , and the various parameters and incidence rate of adverse reaction were recorded.Results After 12-24 h of non-invasive positive pressure ventilation, the level of pH, PaCO2, FiO2 , abdominal distension , the average time of non-invasive ventilation and the failure cases of non-invasive ventilation were respectively （7.32 ±0.06）, （48.2 ±9.0） mmHg, （0.39 ±0.08）, 3 cases, （54.1 ± 16.8） h and 12 cases in the nasal prong group, and were （7.31 ±0.07）, （47.2 ±10.2） mmHg, （0.38 ± 0.08）, 5 cases, （54.8 ±13.6） h and 9 cases in the nasal mask group, and the differences were not statistically significant （t/χ2 =0.169, 0.484, 0.464, 0.217, -0.226, 0.332, respectively;P〉0.05）.The total numbers of falling off and leaking gas were respectively 89 and 352 in the nasal prong group , and were lower than 48 and 489 in the nasal mask group, and the differences were statistically significant （χ2 =8.898, 44.644, respectively;P〈0.05）.No difference was found in the incidence rate of nasal injury between two groups （χ2 =0.009,P〉0.05）.But the sites of nasal injury between two groups were significant different , and the sites of nasal injury in the nasal prong group were almost around the medial aspect of the nasal septum and the columella, and were around the junction of the nasal septum and philtrum and th