CAJ | 학술논문

目的评价同步鼻塞间歇正压通气(synchronized nasal intermittent positive pressure venti-lation,SNIPPV)作为初始通气模式治疗早产儿肺透明膜病(hyaline membrane disease,HMD)的临床疗效. 方法采用前瞻性随机对照研究方法 .选择2008年3月至2009年3月收入我院新生儿重症监护病房的临床诊断HMD的早产儿,应用猪肺磷脂后,对于仍有呼吸困难需无创通气治疗者共42例,随机分为SNIPPV组20例和鼻塞持续正压通气(nasal continuous positive airway pressure,NCPAP)组22例.比较两组上机前后的生命体征、血气分析、无创通气失败率及各种并发症的发生率.两组间比较采用t检验和x~2检验. 结果SNIPPV组上机后3 h及12 h氧分压分别为(78.3±17.6)mm Hg和(83.3±17.7)mm Hg,均高于NCPAP组[分别为(62.5±20.5)mm Hg和(69.6±18.8)mm Hg](P<0.05);二氧化碳分压分别为(42.2±12.2)mm Hg和(41.44±11.2)mm Hg,均低于NCPAP组[分别为(53.74±11.0)mm Hg和(55.3±10.9)mm Hg](P<0.05).SNIPPV组上机后3 h低氧血症及高碳酸血症的发生率分别为5.0%和20.0%,均低于NCPAP组(分别为36.4%和50.0%)(P<0.05),上机后12 h高碳酸血症的发生率也低于NCPAP组(20.0%和59.1%)(x~2=6.654,P=0.010).SNIPPV组无创通气失败率低于NCPAP组(15.0%和45.5%)(x~2=4.456,P=0.033).两组并发症发生率差异无统计学意义.结论 SNIPPV作为应用肺表面活性物质后的初始通气模式治疗早产儿HMD是可行的,且比NCPAP模式更有效.
목적 평개동보비새간헐정압통기(synchronized nasal intermittent positive pressure venti-lation,SNIPPV)작위초시통기모식치료조산인폐투명막병(hyaline membrane disease,HMD)적림상료효. 방법 채용전첨성수궤대조연구방법 .선택2008년3월지2009년3월수입아원신생인중증감호병방적림상진단HMD적조산인,응용저폐린지후,대우잉유호흡곤난수무창통기치료자공42례,수궤분위SNIPPV조20례화비새지속정압통기(nasal continuous positive airway pressure,NCPAP)조22례.비교량조상궤전후적생명체정、혈기분석、무창통기실패솔급각충병발증적발생솔.량조간비교채용t검험화x~2검험. 결과SNIPPV조상궤후3 h급12 h양분압분별위(78.3±17.6)mm Hg화(83.3±17.7)mm Hg,균고우NCPAP조[분별위(62.5±20.5)mm Hg화(69.6±18.8)mm Hg](P<0.05);이양화탄분압분별위(42.2±12.2)mm Hg화(41.44±11.2)mm Hg,균저우NCPAP조[분별위(53.74±11.0)mm Hg화(55.3±10.9)mm Hg](P<0.05).SNIPPV조상궤후3 h저양혈증급고탄산혈증적발생솔분별위5.0%화20.0%,균저우NCPAP조(분별위36.4%화50.0%)(P<0.05),상궤후12 h고탄산혈증적발생솔야저우NCPAP조(20.0%화59.1%)(x~2=6.654,P=0.010).SNIPPV조무창통기실패솔저우NCPAP조(15.0%화45.5%)(x~2=4.456,P=0.033).량조병발증발생솔차이무통계학의의.결론 SNIPPV작위응용폐표면활성물질후적초시통기모식치료조산인HMD시가행적,차비NCPAP모식경유효.
Objective To assess the efficacy of synchronized nasal intermittent positive pressure ventilation (SNIPPV) as primary treatment of hyaline membrane disease (HMD) in premature infants. Methods A prospective randomized controlled trial was conducted. Preterm infants, who were diagnosed as HMD, admitted to the neonatal intensive care unit of Peking University Third Hospital from March 2008 to March 2009 were recruited in the study group. Non-invasive ventilation were given to the infants who still breath with difficulty after surfactant therapy. Twenty infants were randomized to SNIPPV group and 22 comparable infants to NCPAP group. Vital signs, blood gas analysis and prevalence of non-invasive ventilation failure and complications were compared between the two groups, t test and x~2 test were used for statistical analysis. Results Infants treated initially with SNIPPV had a higher PaQ_2 level [(78. 3±17. 6) vs (62. 5±20.5) mm Hg, P<0.05, and (83. 3±17. 7) vs (69. 6±18. 8) mm Hg, P<0. 05] and lower PaCQ_2 level [(42.2±12.2) vs (53.7±11.0) mm Hg, P<0.05, and (41.4±11.2) vs (55.3±10.9) mm Hg, P<0.05] than those treated with NCPAP after 3 and 12 hours' ventilation, respectively. SNIPPV group had a decreased incidence of hypoxemia and hyperbicarbonatemia than NCPAP group after 3 hours' ventilation (5. 0% vs 36.4%, P<0.05,and 20.0% vs 50.0%, P<0.05),and a decreased incidence of hyperbicarbonatemia after 12 hours' ventilation(20.0% vs 59.1%, x~2=6.654,P=0.010). Infants treated initially with SNIPPV had lower incidence of non-invasive ventilation failure than infants treated with NCPAP(15. 0% vs 45. 5%, x~2 =4.456, P=0.033). There was no significant difference on the prevalence of complications between the two groups. Conclusions SNIPPV as a primary measure applied after surfactant therapy is feasible in ventilation of premature infants with HMD and is more effective than NCPAP.