双水平持续正压通气在早产儿呼吸窘迫综合征治疗中的应用

doi:10.13481/j.1671-587x.20150633

摘要/Abstract

摘要：

目的:探讨呼吸窘迫综合征(NRDS)早产儿给予气管插管-肺表面活性物质-拔管(InSurE)治疗联合双水平持续正压通气(BiPAP)对有创呼吸机使用时间的影响,阐明BiPAP在早产儿NRDS治疗中的价值。方法:选择2011年1月—2014年10月诊断为新生儿NRDS并给予InSurE治疗的早产儿95例。早产儿中2013年1月31日前入选的早产儿呼吸策略为气管插管-肺表面活性物质-拔管+鼻塞持续气道正压通气(InSurE+ nCPAP),设为对照组;2013年2月1日后入院早产儿开始使用BiPAP,设为BiPAP组。比较2组InSurE失败率、InSurE失败后1周内需再次气管插管机械通气的比率、无创和有创呼吸机持续时间、常压氧疗时间及并发症的发生情况。结果:① 2组患儿的性别和年龄等临床资料比较差异无统计学意义(P>0.05);② 对照组与BiPAP组间的InSurE失败率比较差异无统计学意义(P=0.595),但BiPAP组1周内重新机械通气的发生率低于对照组(P<0.01)。③ 秩和检验分析,BiPAP组的无创呼吸机持续时间长于对照组(P<0.01),同时BiPAP组的有创呼吸机持续时间、总常压氧疗时间均短于对照组 (P<0.01);④ 临床并发症,BiPAP组的早产儿视网膜病变(ROP)及支气管肺发育不良(BPD)发生率明显低于对照组(P<0.05)。结论:BiPAP可明显减少InSurE失败后气管插管有创呼吸机的使用,从而减少氧中毒和气压伤的危害。

关键词: 双水平持续正压通气, 鼻塞持续气道正压通气, 无创呼吸支持, 呼吸窘迫综合征, InSurE治疗, 早产儿

Abstract:

Objective To explore the influence of intubation-surfactant-extubation (InSurE) therapy combined with bilevel positive airway pressure (BiPAP) in the use time of mechanical ventilation,and to clarify the value of BiPAP in the treatment of respiratory distress syndrome in the preterm infants. Methods Toral 95 preterm infants with respiratory distress syndrome were treated with InSurE therapy during January 2011 to October 2014.Among them,the preterm infants before January 2013 were selected as control group who were treated with InSurE and nasal continuous positive airway pressure (nCPAP).After January 2013,60 preterm infants were treated with BiPAP,as BiPAP group.The rates of InSurE failure,the need for mechanical ventilation (MV) on the 7th day after InSurE failure,total non-invasive ventilation time,total mechanical ventilation time,atmospheric oxygen therapy time and incidence of clinical complications were compared between two groups. Results 1 There were no significant differences in the clinical data of the preterm infants between two groups,such as gender and age.2 Although there was no significant difference in the failure rate of InSurE,but the rate of repeated mechanical ventilation during 1 week in BiPAP group was lower than that in control group (P<0.01).3 The Rank sum test result showed that the total time of non invasive ventilation in BiPAP group was longer than that in control group (P<0.01).The total time of invasive mechanical ventilation and oxygen therapy in BiPAP group was lower than that in control group (P<0.05).4 The incidence of retinopathy of prematurity (ROP) and bronchopulmonary dysplasia (BPD) in BiPAP group was lower than that in control group. Conclusion BiPAP can significantly reduce the use of invasive mechanical ventilation after the failure of InSurE,thereby decreases the oxygen toxicity and barotrauma hazards.

Key words: bilevel positive airway pressure, nasal continuous positive airway pressure, noninvasive ventilation support, respiratory distress syndrome, intubation-surfactant-extubation treatment, preterm infants

中图分类号:

R722.6

赵小朋, 宋燕燕, 张炼, 陈艳艳, 周媛莉, 张庭艳. 双水平持续正压通气在早产儿呼吸窘迫综合征治疗中的应用[J]. 吉林大学学报(医学版), 2015, 41(06): 1270-1274.

ZHAO Xiaopeng, SONG Yanyan, ZHANG Lian, CHEN Yanyan, ZHOU Yuanli, ZHANG Tingyan. Application of bilevel positive airway pressure in treatment of respiratory distress syndrome in preterm infants[J]. Journal of Jilin University Medicine Edition, 2015, 41(06): 1270-1274.

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