中国小儿急救医学
中國小兒急救醫學
중국소인급구의학
CHINESE PEDIATRIC EMERGENCY MEDICINE
2014年
4期
215-219
,共5页
经鼻间歇正压通气%经鼻持续正压通气%极低出生体重儿%呼吸衰竭
經鼻間歇正壓通氣%經鼻持續正壓通氣%極低齣生體重兒%呼吸衰竭
경비간헐정압통기%경비지속정압통기%겁저출생체중인%호흡쇠갈
Nasal intermittent positive pressure ventilation%Nasal continuous positive airway pressure%Very low birth weight infants%Respiratory failure
目的 评价应用经鼻间歇正压通气(nasal intermittent positive pressure ventilation,nIPPV)与经鼻持续正压通气(nasal continuous positive airway pressure,nCPAP)预防极低出生体重儿呼吸衰竭拔管失败的疗效及预后.方法 选择2012年6月至2013年6月河北省儿童医院NICU达到撤机拔气管插管标准,需要继续无创呼吸支持的84例极低出生体重儿(出生体重700 ～1 500g,胎龄27～32周)作为研究对象.于拔气管插管后按随机数字表法将研究对象分为nIPPV组(40例)和nCPAP组(44例),分别于拔管0、24、48、72 h进行血气分析,监测PaO2、PaCO2、FiO2以及PaO2/FiO2,统计无创辅助通气时间,氧暴露时间.计算拔管成功率(以nIPPV或nCPAP作为拔管后呼吸支持模式而不需再次气管插管的比例),拔管后频发呼吸暂停、支气管肺发育不良、脑室内出血、脑室周围脑白质软化和早产儿视网膜病的发生率以及治愈率、放弃治疗率、病死率.结果 两组患儿的原发病构成比、性别、体重、胎龄、新生儿急性生理学评分及应用肺表面活性物质比较差异无统计学意义(P＞0.05).无创辅助通气治疗48、72h时,nIPPV组PaO2、PaO2/FiO2高于nCPAP组[48h:PaO2:(63.2±3.6) mmHg vs (52.3±6.7)mmHg,PaO2/FiO2:(243.2±32.8)mmHg vs(187.6±34.0)mmHg; 72 h:PaO2:(66.4±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/FiO2:(280.6±16.8)mmHg vs(245.2±40.5)mmHg;1 mmHg=0.133 kPa],PaCO2低于nCPAP组[48 h:(40.3 ±4.8)mmHg vs (49.2 ±6.6)mmHg,72 h:(42.2±5.6) mmHg vs(57.3±6.9) mmHg],差异有统计学意义(P＜0.05).nIPPV组与nCPAP组患儿无创通气时间差异有统计学意义[(130.9 ±46.7) hvs (180.5 ±50.1) h,P＜0.05];氧暴露时间差异无统计学意义[(190.6±45.2)hvs (216.8 ±54.4)h,P＞0.05].nIPPV组与nCPAP组患儿拔管成功率比较差异有统计学意义[92.5％(37/40) vs 75.0％(33/44),P＜0.05];频发呼吸暂停的发生率差异有统计学意义[15.0％ (6/40)vs34.1％ (15/44),P＜0.05].nIPPV组患儿支气管肺发育不良发生率低于nCPAP组[2.5％ (1/40) vs15.9％ (7/44)],差异有统计学意义(P＜0.05).脑室内出血、脑室周围脑白质软化、早产儿视网膜病变、晚发感染、坏死性小肠结肠炎、动脉导管未闭及动脉导管未闭手术的发生率相比差异无统计学意义(P＞0.05).两组患儿病死率比较差异无统计学意义(P＞0.05).结论 niPPY能够更明显改善患儿肺部氧合功能,缩短无创辅助通气时间,提高机械通气拔管成功率,并可减少极低出生体重儿频发呼吸暂停及支气管肺发育不良发生率.
目的 評價應用經鼻間歇正壓通氣(nasal intermittent positive pressure ventilation,nIPPV)與經鼻持續正壓通氣(nasal continuous positive airway pressure,nCPAP)預防極低齣生體重兒呼吸衰竭拔管失敗的療效及預後.方法 選擇2012年6月至2013年6月河北省兒童醫院NICU達到撤機拔氣管插管標準,需要繼續無創呼吸支持的84例極低齣生體重兒(齣生體重700 ～1 500g,胎齡27～32週)作為研究對象.于拔氣管插管後按隨機數字錶法將研究對象分為nIPPV組(40例)和nCPAP組(44例),分彆于拔管0、24、48、72 h進行血氣分析,鑑測PaO2、PaCO2、FiO2以及PaO2/FiO2,統計無創輔助通氣時間,氧暴露時間.計算拔管成功率(以nIPPV或nCPAP作為拔管後呼吸支持模式而不需再次氣管插管的比例),拔管後頻髮呼吸暫停、支氣管肺髮育不良、腦室內齣血、腦室週圍腦白質軟化和早產兒視網膜病的髮生率以及治愈率、放棄治療率、病死率.結果 兩組患兒的原髮病構成比、性彆、體重、胎齡、新生兒急性生理學評分及應用肺錶麵活性物質比較差異無統計學意義(P＞0.05).無創輔助通氣治療48、72h時,nIPPV組PaO2、PaO2/FiO2高于nCPAP組[48h:PaO2:(63.2±3.6) mmHg vs (52.3±6.7)mmHg,PaO2/FiO2:(243.2±32.8)mmHg vs(187.6±34.0)mmHg; 72 h:PaO2:(66.4±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/FiO2:(280.6±16.8)mmHg vs(245.2±40.5)mmHg;1 mmHg=0.133 kPa],PaCO2低于nCPAP組[48 h:(40.3 ±4.8)mmHg vs (49.2 ±6.6)mmHg,72 h:(42.2±5.6) mmHg vs(57.3±6.9) mmHg],差異有統計學意義(P＜0.05).nIPPV組與nCPAP組患兒無創通氣時間差異有統計學意義[(130.9 ±46.7) hvs (180.5 ±50.1) h,P＜0.05];氧暴露時間差異無統計學意義[(190.6±45.2)hvs (216.8 ±54.4)h,P＞0.05].nIPPV組與nCPAP組患兒拔管成功率比較差異有統計學意義[92.5％(37/40) vs 75.0％(33/44),P＜0.05];頻髮呼吸暫停的髮生率差異有統計學意義[15.0％ (6/40)vs34.1％ (15/44),P＜0.05].nIPPV組患兒支氣管肺髮育不良髮生率低于nCPAP組[2.5％ (1/40) vs15.9％ (7/44)],差異有統計學意義(P＜0.05).腦室內齣血、腦室週圍腦白質軟化、早產兒視網膜病變、晚髮感染、壞死性小腸結腸炎、動脈導管未閉及動脈導管未閉手術的髮生率相比差異無統計學意義(P＞0.05).兩組患兒病死率比較差異無統計學意義(P＞0.05).結論 niPPY能夠更明顯改善患兒肺部氧閤功能,縮短無創輔助通氣時間,提高機械通氣拔管成功率,併可減少極低齣生體重兒頻髮呼吸暫停及支氣管肺髮育不良髮生率.
목적 평개응용경비간헐정압통기(nasal intermittent positive pressure ventilation,nIPPV)여경비지속정압통기(nasal continuous positive airway pressure,nCPAP)예방겁저출생체중인호흡쇠갈발관실패적료효급예후.방법 선택2012년6월지2013년6월하북성인동의원NICU체도철궤발기관삽관표준,수요계속무창호흡지지적84례겁저출생체중인(출생체중700 ～1 500g,태령27～32주)작위연구대상.우발기관삽관후안수궤수자표법장연구대상분위nIPPV조(40례)화nCPAP조(44례),분별우발관0、24、48、72 h진행혈기분석,감측PaO2、PaCO2、FiO2이급PaO2/FiO2,통계무창보조통기시간,양폭로시간.계산발관성공솔(이nIPPV혹nCPAP작위발관후호흡지지모식이불수재차기관삽관적비례),발관후빈발호흡잠정、지기관폐발육불량、뇌실내출혈、뇌실주위뇌백질연화화조산인시망막병적발생솔이급치유솔、방기치료솔、병사솔.결과 량조환인적원발병구성비、성별、체중、태령、신생인급성생이학평분급응용폐표면활성물질비교차이무통계학의의(P＞0.05).무창보조통기치료48、72h시,nIPPV조PaO2、PaO2/FiO2고우nCPAP조[48h:PaO2:(63.2±3.6) mmHg vs (52.3±6.7)mmHg,PaO2/FiO2:(243.2±32.8)mmHg vs(187.6±34.0)mmHg; 72 h:PaO2:(66.4±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/FiO2:(280.6±16.8)mmHg vs(245.2±40.5)mmHg;1 mmHg=0.133 kPa],PaCO2저우nCPAP조[48 h:(40.3 ±4.8)mmHg vs (49.2 ±6.6)mmHg,72 h:(42.2±5.6) mmHg vs(57.3±6.9) mmHg],차이유통계학의의(P＜0.05).nIPPV조여nCPAP조환인무창통기시간차이유통계학의의[(130.9 ±46.7) hvs (180.5 ±50.1) h,P＜0.05];양폭로시간차이무통계학의의[(190.6±45.2)hvs (216.8 ±54.4)h,P＞0.05].nIPPV조여nCPAP조환인발관성공솔비교차이유통계학의의[92.5％(37/40) vs 75.0％(33/44),P＜0.05];빈발호흡잠정적발생솔차이유통계학의의[15.0％ (6/40)vs34.1％ (15/44),P＜0.05].nIPPV조환인지기관폐발육불량발생솔저우nCPAP조[2.5％ (1/40) vs15.9％ (7/44)],차이유통계학의의(P＜0.05).뇌실내출혈、뇌실주위뇌백질연화、조산인시망막병변、만발감염、배사성소장결장염、동맥도관미폐급동맥도관미폐수술적발생솔상비차이무통계학의의(P＞0.05).량조환인병사솔비교차이무통계학의의(P＞0.05).결론 niPPY능구경명현개선환인폐부양합공능,축단무창보조통기시간,제고궤계통기발관성공솔,병가감소겁저출생체중인빈발호흡잠정급지기관폐발육불량발생솔.
Objective To evaluate the efficacy of nasal intermittent positive pressure ventilation (nIPPV) in preventing extubation failure in very low birth weight infants (VLBWI) compared with nasal continuous positive airway pressure (nCPAP).Methods A single-center randomized controlled trial was conducted from Jun 2012 to Jun 2013 in the NICU of Children's Hospital of Hebei Province.Eighty-four cases of VLBWI (birth weight 700 ～ 1 500 g,gestational age 27 ～ 32 weeks) with respiratory failure and subjected to mechanical ventilation were eligible for the study if they needed non-invasive,assisted ventilation at the time of first extubation attempt.They were randomly assigned to receive nIPPV (40 cases) or nCPAP (44 cases) according to random number table method,using the rate of successful extubation as primary outcome.Blood gas data were obtained and PaO2,PaCO2,FiO2,PaO2/FiO2 were monitored at 0 h,24 h,48 h and 72 h after extubation as enrollment for oxygenation and duration,the rate of successful extubation and the incidence of adverse events including frequent apnea,bronchopulmonary dysplasia,intraventricular hemorrhage,periventricular leukomalacia and retinopathy of prematurity and mortality as secondary outcomes.Results There were no significant differences in the baseline characteristics including the proportion of primary disease,sex,weight,gestational age,score for neonatal acute physiology and application of pulmonary surfactant between nIPPV group and nCPAP group (P ＞ 0.05).There were no significant differences in PaO2,PaCO2 and PaO2/FiO2 ratio between the two groups at 0 h of enrollment (P ＞ 0.05).The values of PaO2 and PaO2/FiO2 ratio in nIPPV group were significantly higher[48 h:PaO2:(63.2 ± 3.6) mmHg vs (52.3 ±6.7) mmHg,PaO2/FiO2:(243.2 ±32.8) mmHg vs (187.6 ±34.0) mmHg;72 h:PaO2:(66.4 ±5.8) mmHg vs (51.8±5.9) mmHg,PaO2/EO2:(280.6 ± 16.8) mmHg vs (245.2 ±40.5) mrnHg;1 rnmHg =0.133 kPa],whereas PaCO2 lower[48 h:(40.3 ±4.8) mmHg vs (49.2 ±6.6) mmHg,72 h:(42.2 ±5.6) mmHg vs (57.3 ± 6.9) mmHg],than nCPAP group at 48 h and 72 h after extubation (P ＜ 0.05).The oxygenation status in nIPPV group were significantly improved at 48 h and 72 h after extubation compared with the intra-group data at 0 h (P ＜ 0.05).The total ventilation time was shorter in nIPPV group than nCPAP group[(130.9 ±46.7) h vs (180.5 ±50.1) h,P ＜0.05],but the oxygen exposure time had no significant difference[(190.6 ± 45.2) h vs (216.8 ± 54.4) h,P ＞ 0.05].The rate of successful extubation in nIPPV group was significantly higher as compared with nCPAP group[92.5％ (37/40) vs 75.0％ (33/44),P ＜ 0.05].The incidence of frequent apnea and bronchopulmonary dysplasia in nIPPV was lower than nCPAP group[15.0％ (6/40) vs 34.1％ (15/44) ;2.5％ (1/40) vs 15.9％ (7/44),P ＜ 0.05].There were no significant differences in the incidence of severe intraventricular hemorrhage,perivenwicular leukomalacia,retinopathy of prematurity,late of infections,necrotizing enterocolitis,patent ductus arteriosus,patent ductus arteriosus operation and mortality before discharge between the two groups (P ＞ 0.05).Conclusion nIPPV after extubation in VLBWI has beneficial effects as compared with nCPAP in improving oxygenation,shortening noninvasive ventilation time,improving the rate of successful extubation,and can reduce the incidence of frequent apnea and bronchial pulmonary dysplasia in VLBWI.
