CAJ | 학술논문

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。
목적：료해비새여비조재무창통기치료조산인호흡군박종합정（ RDS ）중적특점。방법선취2012년8월-2013년6월수치적부합입선표준적RDS조산인，안조수궤수자표법장환인분위비새조（48례）여비조조（45례）。비새조적무창통기련접계면선용단적쌍비새，비조조선용비조。근거경피혈양포화도혹혈기분석조정FiO2등삼수，기록각충삼수급불량반응적발생솔。결과비새조무창정압통기후12～24 h혈기분석적pH치위（7．32±0．06），PaCO2치위（48．2±9．0） mmHg，정압통기24 h시FiO2치위（0．39±0．08），복창3례，평균무창통기시간（54．1±16．8）h，무창통기실패12례；비조조분별위（7．31±0．07），（47．2±10．2）mmHg，（0．38±0．08），5례，（54．8±13．6）h，9례，량조비교차이균무통계학의의（t/χ2치분별위0．169，0．484，0．464，0．217，-0．226，0．332；P＞0．05）。비새조총탈락차수89차，총루기차수352차，저우비조조적48，489차，차이유통계학의의（χ2치분별위8．898，44．644；P＜0．05）。량조국부피부손상발생솔비교，차이무통계학의의（χ2＝0．009，P＞0．05），단피부손상부위명현불동：비새조피부손상부위절대부분재비중격적내측화비소주，비조조피부손상부위절대부분재비중격여인중련접처급미간。결론비새교비조경용역탈락，비조비비새경용역루기，단저량충련접계면대무창통기시간급무창통기실패솔등병무명현적영향。비새화비조도치비부손상적발생솔급정도기본상사，단손상부위명현불동。
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 the glabella in the nasal mask group.Conclusions The nasal prongs fall off more easily than nasal masks , and the nasal mask leaks more easily than nasal prongs , but there are no significant differences in the duration and the failure rate of noninvasive ventilation between the two types of connection interfaces .The incidence rate and degree of nasal injury causes by the nasal prongs or nasal mask are similar , but the sites of nasal injury are different .