中华临床医师杂志(电子版) 2017年2月,11卷3期

临床论著

不同无创通气模式联合肺表面活性物质在新生儿 呼吸窘迫综合征初始呼吸支持的临床应用

吴杰斌1 周彬1 翟敬芳2 金宝1 蒋红侠1 刘娅1 周广玲1

221009 江苏省,徐州市中心医院儿科1,产科2
周彬,Email: zekzj@163.com

摘要:  目的 探讨三种不同无创辅助通气模式联合肺表面活性物质(PS)在新生儿呼吸窘迫综合征(NRDS)初始呼吸支持治疗的临床应用效果。方法 2014年6月至2016年8月东南大学附属徐州医院新生儿重症监护病房(NICU)收治105例NRDS患儿,予以无创辅助通气联合PS,随机将患儿分为三组:鼻塞式双水平正压通气(nDuoPAP)组38例,鼻塞式同步间歇指令通气(nSIMV)组34例,鼻塞式持续气道正压通气(nCPAP)组33例,主要观察三组使用无创呼吸支持后1 h、6 h、24 h的pH值、二氧化碳分压(PaCO2)、血氧分压(PaO2)、P/F比值(P/F= PaO2/FiO2),无创辅助通气失败需要进行有创机械通气例数以及PS应用例数情况,采用方差分析及χ2检验等统计学分析。结果 nDuoPAP、nSIMV组无创辅助通气后1 h、6 h、24 h PaCO2、PaO2、P/F比值分别与nCPAP组比较有明显改善,差异均有统计学意义(P<0.05);nDuoPAP、nSIMV组PS应用例数与nCPAP组比较,明显少于nCPAP组,差异有统计学意义(P<0.05);前两组间差异均无统计学意义(P>0.05)。三组pH值、无创辅助通气失败需要进行有创机械通气例数、无创辅助通气时间、气漏综合征、支气管肺发育不良(BPD)、早产儿视网膜病(ROP)及脑室周围-脑室内出血(PVH-IVH)发生率差异均无统计学意义(P>0.05)。结论 nDuoPAP、nSIMV用于NRDS初始呼吸支持治疗,与nCPAP相比能有效改善氧合,减少CO2潴留,同时减少外源性PS的使用,不增加相关并发症,值得重视。

关键词: 鼻塞式双水平正压通气; 鼻塞式同步间歇指令通气; 持续气道正压通气; 肺表面活性物质; 呼吸窘迫综合征

徐州市科技局医学科研课题项目(KC14SH025)

Clinical application of different kinds of non-invasive ventilation with pulmonary surfactant in the initial respiratory support of newborns respiratory distress syndrome

Wu Jiebin1, Zhou Bin1, Zhai Jingfang2, Jin Bao1, Jiang Hongxia1, Liu Ya1, Zhou Guang-ling1

1Department of Pediatrics, 2Department of Obstetrics, Xuzhou Central Hospital, Xuzhou 221009, China
Zhou Bin, Email: zekzj@163.com

Abstract:  Objective To investigate the clinical effects of three various non-invasive ventilation modes with pulmonary surfactant (PS) in the initial respiratory support of newborns respiratory distress syndrome (NRDS). Methods 105 cases infants with NRDS who were received non-invasive ventilation combined with pulmonary surfactant from the Affiliated Xuzhou Hospital of Southeast University neonatal intensive care unit (NICU) from June 2014 to August 2016 were randomly divided into three groups, nasal Duo positive airway pressure (nDuoPAP) group 38 cases, nasal synchronized intermittent mandatory ventilation (nSIMV) group 34 cases, nasal continuous positive airway pressure (nCPAP) group 33 cases. The main observation was the comparison of pH value, partial pressure of carbon dioxide (PaCO2), partial pressure of oxygen (PaO2), P/F ratio (P/F=PaO2/FiO2), failure cases required to non-invasive mechanical ventilation and the number of PS applications in three groups after 1 h, 6 h, 24 h, using χ2 test and variance statistical analysis methods. Results PaCO2, PaO2, P/F ratio at 1 h, 6 h, 24 h during using non-invasive positive pressure ventilation were improved significantly in nDuoPAP and nSIMV group compared with nCPAP group (P<0.05). The number of pulmonary surfactant (PS) applied in nDuoPAP and nSIMV group was significantly lower than that in nCPAP group (P<0.05). There was no statistical significance of those above between nDuoPAP and nSIMV group (P>0.05). There was no statistical significance in three groups in pH and the noninvasive ventilation time and gas leak syndrome and bronchopulmonary dysplasia (BPD) and retinopathy of premature children (ROP) and periventricular-intraventricular haemorrhage (PVH-IVH) (P>0.05). Conclusions nDuoPAP and nSIMV could improve oxygenation and reduce CO2 retention and reduce the use of exogenous pulmonary surfactant without the relevant complications. It is worthy of our attention.

Keywords:Nasal Duo positive airway pressure; Nasal synchronized intermittent mandatory ventilation; Continuous positive airway pressure, pulmonary surfactant; Respiratory distress syndrome; Premature infant

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(编辑:戚红丹 收稿日期:2016-10-20)