中华妇幼临床医学杂志（电子版）
中華婦幼臨床醫學雜誌（電子版）
중화부유림상의학잡지（전자판）
CHINESE JOURNAL OF OBSTETRICS & GYNECOLOGY AND PEDIATRICS(ELECTRONIC VERSION)
2014年
4期
511-515
,共5页
廖积仁%刘玉婵%谭菁%陈烨%王平%李科翔%唐伟淘
廖積仁%劉玉嬋%譚菁%陳燁%王平%李科翔%唐偉淘
료적인%류옥선%담정%진엽%왕평%리과상%당위도
间歇正压通气%连续气道正压通气%呼吸窘迫综合征,新生儿%婴儿,早产
間歇正壓通氣%連續氣道正壓通氣%呼吸窘迫綜閤徵,新生兒%嬰兒,早產
간헐정압통기%련속기도정압통기%호흡군박종합정,신생인%영인,조산
Intermittent positive-pressure ventilation%Continuous positive airway pressure%Respiratory distress syndrome,newborn%Infant,premature
目的：探讨早产儿合并新生儿呼吸窘迫综合征(NRDS)在“气管插管-应用肺表面活性物质-拔管”(INSURE)后使用经鼻同步间歇正压通气(NSIPPV)与经鼻持续正压通气(NCPAP)治疗的疗效及安全性。方法选择2012年1月至2013年7月于湖南省株洲市妇幼保健院新生儿科住院治疗的51例早产合并 NRDS,并需进行呼吸支持患儿为研究对象。将其按照呼吸支持治疗方式,分为 NSIPPV组(n=25)与NCPAP 组(n=26)。分析比较两组患儿于呼吸支持治疗前及呼吸支持治疗后6 h、24 h、48 h等时间点的动脉氧分压(PaO2)、动脉二氧化碳分压(PaCO2)、呼吸指数(RI)、并发症及转归情况等(本研究遵循的程序符合湖南省株洲市妇幼保健院人体试验委员会制定的伦理学标准,得到该委员会批准,分组征得受试对象监护人知情同意,并与监护人签署临床研究知情同意书)。两组患儿性别、胎龄、出生体质量等一般临床资料比较,差异无统计学意义(P>0.05)。结果本研究结果为：①两组患儿在治疗前,PaO2、PaCO2及 RI 比较,差异均无统计学意义(P>0.05)；②PaO2水平比较：两组在治疗后6 h及24 h比较时,差异均无统计学意义(P>0.05),但治疗后48 h时,NSIPPV组显著高于 NCPAP组,且差异有统计学意义(P<0.01)；两组均在治疗后6h、24h及48h时较同组治疗前显著增高,治疗后24h及48h时较同组治疗后6h时显著增高,且差异均有统计学意义(P<0.01),但治疗后24 h 时与同组治疗后48 h 时比较,差异无统计学意义(P>0.05)；③PaCO2水平比较：两组在治疗后各时间点比较,差异均无统计学意义(P>0.05)；两组均在治疗后6 h时与同组治疗前比较及治疗后24 h 时与同组治疗后48 h 时比较,差异均无统计学意义(P>0.05),但两组均在治疗后24 h、48 h时较同组治疗前及治疗后24 h、48 h时较同组治疗后6 h时显著降低,且差异均有统计学意义(P<0.01)；④RI 比较：NSIPPV 组在治疗后6 h、24 h 及48 h 时均显著低于NCPAP组,且差异有统计学意义(P<0.01)；两组治疗后每个时间点分别与同组前面比较,差异均有统计学意义(P<0.01)；⑤两组再插管率及腹胀发生率比较,差异均无统计学意义(P>0.05),但 NSIPPV 组经鼻通气时间显著少于NCPAP组,且差异有统计学意义(P<0.05),两组均无一例患儿发生支气管肺发育不良(BPD)、颅内出血及气漏。结论 NSIPPV及 NCPAP 2种无创通气模式对治疗 NRDS均有较好疗效,能显著改善肺部氧合功能,且二氧化碳储留均不明显；2种模式安全性均较好；NSIPPV较 NCPAP 更有效,经鼻通气时间更短,改善肺的通气及氧交换能力更强。
目的：探討早產兒閤併新生兒呼吸窘迫綜閤徵(NRDS)在“氣管插管-應用肺錶麵活性物質-拔管”(INSURE)後使用經鼻同步間歇正壓通氣(NSIPPV)與經鼻持續正壓通氣(NCPAP)治療的療效及安全性。方法選擇2012年1月至2013年7月于湖南省株洲市婦幼保健院新生兒科住院治療的51例早產閤併 NRDS,併需進行呼吸支持患兒為研究對象。將其按照呼吸支持治療方式,分為 NSIPPV組(n=25)與NCPAP 組(n=26)。分析比較兩組患兒于呼吸支持治療前及呼吸支持治療後6 h、24 h、48 h等時間點的動脈氧分壓(PaO2)、動脈二氧化碳分壓(PaCO2)、呼吸指數(RI)、併髮癥及轉歸情況等(本研究遵循的程序符閤湖南省株洲市婦幼保健院人體試驗委員會製定的倫理學標準,得到該委員會批準,分組徵得受試對象鑑護人知情同意,併與鑑護人籤署臨床研究知情同意書)。兩組患兒性彆、胎齡、齣生體質量等一般臨床資料比較,差異無統計學意義(P>0.05)。結果本研究結果為：①兩組患兒在治療前,PaO2、PaCO2及 RI 比較,差異均無統計學意義(P>0.05)；②PaO2水平比較：兩組在治療後6 h及24 h比較時,差異均無統計學意義(P>0.05),但治療後48 h時,NSIPPV組顯著高于 NCPAP組,且差異有統計學意義(P<0.01)；兩組均在治療後6h、24h及48h時較同組治療前顯著增高,治療後24h及48h時較同組治療後6h時顯著增高,且差異均有統計學意義(P<0.01),但治療後24 h 時與同組治療後48 h 時比較,差異無統計學意義(P>0.05)；③PaCO2水平比較：兩組在治療後各時間點比較,差異均無統計學意義(P>0.05)；兩組均在治療後6 h時與同組治療前比較及治療後24 h 時與同組治療後48 h 時比較,差異均無統計學意義(P>0.05),但兩組均在治療後24 h、48 h時較同組治療前及治療後24 h、48 h時較同組治療後6 h時顯著降低,且差異均有統計學意義(P<0.01)；④RI 比較：NSIPPV 組在治療後6 h、24 h 及48 h 時均顯著低于NCPAP組,且差異有統計學意義(P<0.01)；兩組治療後每箇時間點分彆與同組前麵比較,差異均有統計學意義(P<0.01)；⑤兩組再插管率及腹脹髮生率比較,差異均無統計學意義(P>0.05),但 NSIPPV 組經鼻通氣時間顯著少于NCPAP組,且差異有統計學意義(P<0.05),兩組均無一例患兒髮生支氣管肺髮育不良(BPD)、顱內齣血及氣漏。結論 NSIPPV及 NCPAP 2種無創通氣模式對治療 NRDS均有較好療效,能顯著改善肺部氧閤功能,且二氧化碳儲留均不明顯；2種模式安全性均較好；NSIPPV較 NCPAP 更有效,經鼻通氣時間更短,改善肺的通氣及氧交換能力更彊。
목적：탐토조산인합병신생인호흡군박종합정(NRDS)재“기관삽관-응용폐표면활성물질-발관”(INSURE)후사용경비동보간헐정압통기(NSIPPV)여경비지속정압통기(NCPAP)치료적료효급안전성。방법선택2012년1월지2013년7월우호남성주주시부유보건원신생인과주원치료적51례조산합병 NRDS,병수진행호흡지지환인위연구대상。장기안조호흡지지치료방식,분위 NSIPPV조(n=25)여NCPAP 조(n=26)。분석비교량조환인우호흡지지치료전급호흡지지치료후6 h、24 h、48 h등시간점적동맥양분압(PaO2)、동맥이양화탄분압(PaCO2)、호흡지수(RI)、병발증급전귀정황등(본연구준순적정서부합호남성주주시부유보건원인체시험위원회제정적윤리학표준,득도해위원회비준,분조정득수시대상감호인지정동의,병여감호인첨서림상연구지정동의서)。량조환인성별、태령、출생체질량등일반림상자료비교,차이무통계학의의(P>0.05)。결과본연구결과위：①량조환인재치료전,PaO2、PaCO2급 RI 비교,차이균무통계학의의(P>0.05)；②PaO2수평비교：량조재치료후6 h급24 h비교시,차이균무통계학의의(P>0.05),단치료후48 h시,NSIPPV조현저고우 NCPAP조,차차이유통계학의의(P<0.01)；량조균재치료후6h、24h급48h시교동조치료전현저증고,치료후24h급48h시교동조치료후6h시현저증고,차차이균유통계학의의(P<0.01),단치료후24 h 시여동조치료후48 h 시비교,차이무통계학의의(P>0.05)；③PaCO2수평비교：량조재치료후각시간점비교,차이균무통계학의의(P>0.05)；량조균재치료후6 h시여동조치료전비교급치료후24 h 시여동조치료후48 h 시비교,차이균무통계학의의(P>0.05),단량조균재치료후24 h、48 h시교동조치료전급치료후24 h、48 h시교동조치료후6 h시현저강저,차차이균유통계학의의(P<0.01)；④RI 비교：NSIPPV 조재치료후6 h、24 h 급48 h 시균현저저우NCPAP조,차차이유통계학의의(P<0.01)；량조치료후매개시간점분별여동조전면비교,차이균유통계학의의(P<0.01)；⑤량조재삽관솔급복창발생솔비교,차이균무통계학의의(P>0.05),단 NSIPPV 조경비통기시간현저소우NCPAP조,차차이유통계학의의(P<0.05),량조균무일례환인발생지기관폐발육불량(BPD)、로내출혈급기루。결론 NSIPPV급 NCPAP 2충무창통기모식대치료 NRDS균유교호료효,능현저개선폐부양합공능,차이양화탄저류균불명현；2충모식안전성균교호；NSIPPV교 NCPAP 경유효,경비통기시간경단,개선폐적통기급양교환능력경강。
Objective To investigate efficacy and safety of nasal synchronized intermittent positive pressure ventilation (NSIPPV)and nasal continuous positive airway pressure (NCPAP)after INSURE procedure in the treatment of neonatal respiratory distress syndrome (NRDS ) in premature infants. Methods A total of 5 1 premature infants who were diagnosed as NRDS and required respiratory support hospitalization and treatment in neonatal department of Zhuzhou Maternal and Child Health Care Hospital of Hunan Province from January 2012 to July 2013 were chosen as study subjects.They were randomly assigned to NSIPPV group (n=25)and NCPAP group (n=26)in accordance with the respiratory support mode.The arterial oxygen pressure(PaO2 ),arterial carbon dioxide tension(PaCO2 ),respiratory index(RI), complications and outcomes before respiratory support and 6 h,24 h,48 h after respiratory support between two groups were analyzed and compared.The study protocol was approved by the Ethical Review Board of Investigation in Human Beings of Zhuzhou Maternal and Child Health Care Hospital.Informed consent was obtained from the parents of each participating patient.The general clinical data such as gender,gestational age and birth weight between two groups had no statistically significant difference(P>0.05).Results The results of this study followed as:①The PaO2 ,PaCO2 and RI levels prior treatment between two groups had no statistically significant difference(P>0.05).②Comparison of PaO2 level:There were no statistically significant difference between two groups 6 h and 24 h post-treatment(P>0.05),but the PaO2 level of NSIPPV group was statistically higher than that of NCPAP group 48 h post-treatment(P<0.01);The PaO2 level in the two groups both were statistically higher compared 6 h,24 h,48 h post-treatment to prior treatment and compared 24 h,48 h post-treatment to 6 h post-treatment in the same group(P<0.01),but compared 24 h post-treatment to 48 h post-treatment in the same group had no statistically significant difference(P>0.05).③Comparison of PaCO2 level:There were no statistically significant difference between two groups in three time points post-treatment(P>0.05);The PaCO2 level in the two groups both had no significant difference compared 6 h post-treatment to prior treatment and compared 24 h post-treatment to 48 h post-treatment in the same group (P>0.05 ),but the PaCO2 level in the two groups both were statistically lower compared 24 h,48 h post-treatment to prior treatment and compared 24 h,48 h post-treatment to 6 h post-treatment in the same group(P<0.01).④Comparison of RI level:The RI level of NSIPPV group was statistically lower than that of NCPAP group at 6 h,24 h,48 h post-treatment(P<0.01);The RI level in the two groups both were statistically lower compared each time point after treatment to any prior time point in the same group (P<0.01).⑤The reintubation rate and abdominal distension incidence between two groups had no statistically significant difference(P>0.05),but nasal ventilation time of NSIPPV group was statistically less than NCPAP group (P<0.05 ).Both groups had no bronchial pulmonary dysplasia(BPD),intracranial hemorrhage and gas leakage.Conclusions NSIPPV and NCPAP two kinds of noninvasive ventilation mode for treatment of NRDS had a good effect,which can significantly improve lung oxygenation function.Carbon dioxide retention was not obvious.Both modes had better safety.NSIPPV was more efficient than NCPAP for treatment of NRDS,nasal ventilation time was shorter and the capacity to improve pulmonary ventilation and oxygen exchange was greater.
