天津医药

天津医药 ›› 2019, Vol. 47 ›› Issue (10): 1067-1072.doi: 10.11958/20191858

• 临床研究 • 上一篇    下一篇

两种不同无创通气策略治疗新生儿呼吸窘迫综合征疗效分析

朱柳杰 1，2，任广立 2△，谢聪 3，张庆梅 2，谢国强 2   

  1. 1广州中医药大学（邮编510405）；2中国人民解放军南部战区总医院儿科；3广州医科大学附属第二医院儿科
  • 收稿日期:2019-06-20 修回日期:2019-09-18 出版日期:2019-10-15 发布日期:2019-11-11
  • 通讯作者: 任广立 E-mail:guangliren@hotmail.com
  • 基金资助:
    广东省广州市科技计划项目

Efficacy analysis of two different noninvasive ventilation strategies in neonatal respiratory distress syndrome

ZHU Liu-jie1，2, REN Guang-li2△, XIE Cong3, ZHANG Qing-mei2, XIE Guo-qiang2   

  1. 1 Guangzhou University of Chinese Medicine, Guangzhou 510405, China; 2 Department of Pediatrics, General Hospital of Southern Theatre Command of PLA; 3 Department of Pediatrics, the Second Affiliated Hospital of Guangzhou Medical University
  • Received:2019-06-20 Revised:2019-09-18 Published:2019-10-15 Online:2019-11-11
  • Supported by:
     

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摘要： 摘要：目的 比较经鼻间歇正压通气（NIPPV）联合经鼻持续正压通气（NCPAP）与单独NCPAP治疗新生儿呼吸 窘迫综合征（RDS）的临床疗效。方法 将2018年1月—2019年6月收治的102例RDS患儿随机分为NIPPV+NCPAP 组（50例）和NCPAP组（52例），比较应用NIPPV+NCPAP和NCPAP治疗RDS患儿后，2种方法在改善呼吸频率、改善 氧合、降低乳酸值、减少通气失败及相关并发症之间有无差异。根据通气结局将全体患儿分为通气失败组（34例）和 通气成功组（68例），分析2组患儿吸入氧体积分数（FiO2）及乳酸变化对通气结局的影响。结果 NIPPV+NCPAP组 通气支持1、6、12 h时，在降低呼吸频率、提高氧分压、改善氧合方面显著优于NCPAP组（均P＜0.05）；NIPPV+NCPAP 组血乳酸随通气时间呈下降趋势，通气12 h时，血乳酸显著低于NCPAP组（P＜0.05）；NIPPV+NCPAP组通气失败及 呼吸暂停比例显著低于NCPAP组（均P＜0.05）；而2组患儿无创通气时间、脱离无创后单独吸氧时间、达全肠道喂养 时间、住院时间、住院费用及因烦躁使用水合氯醛镇静次数、喂养不耐受、坏死性小肠结肠炎、败血症、动脉导管未 闭、颅内出血、支气管肺发育不良等并发症发生率差异均无统计学意义（均P＞0.05）。与通气成功组相比，通气失败 组患儿出生2 h内FiO2≥0.30及乳酸值持续升高者明显较多（均P＜0.05）。结论 应用NIPPV联合NCPAP无创通气 策略治疗新生儿呼吸窘迫综合征安全、有效，值得推广。

关键词: 呼吸窘迫综合征, 新生儿, 间歇正压通气, 连续气道正压通气, 乳酸

Abstract: Abstract：Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation combined with nasal continuous positive airway pressure (NIPPV+NCPAP) and nasal continuous positive airway pressure (NCPAP) in the treatment of neonatal respiratory distress syndrome. Methods A total of 102 newborns with respiratory distress syndrome (RDS) who were admitted between January 2018 to June 2019 were randomly divided into two groups NIPPV+ NCPAP group (n=50) and NCPAP group (n=52). The differences in the improving respiratory rate, oxygen and reduce lactic acid value, ventilation failure, related complications were compared in newborns with RDS between NIPPV+NCPAP group and NCPAP group. According to the ventilation outcome, all the newborns were divided into failed ventilation group (n=34) and successful ventilation group (n=68). The effects of inhaled oxygen volume fraction (FiO2) and lactic acid on the outcome of ventilation were analyzed in the two groups. Results The reducing breath rate, increasing oxygen partial pressure and improving oxygen at 1 h, 6 h, and 12 h were significantly better in NIPPV+NCPAP group than those of NCPAP group (all P＜ 0.05). The lactic acid value decreased with ventilation time in NIPPV+NCPAP group. After ventilation for 12 h, the lactate value was significantly lower in NIPPV + NCPAP group than that of NCPAP group (P＜0.05). The ventilation failure and apnea also reduced in NIPPV+NCPAP group than those of NCPAP group (all P＜0.05). There were no significant differences  in non-invasive ventilation time, no oxygenation time after non-invasive surgery, total intestinal feeding time, hospitalization
time, hospitalization expenses, and complications such as chlorination of chloral hydrate due to irritability, feeding
intolerance, necrotizing enterocolitis, sepsis, patent ductus arteriosus, intracranial hemorrhage, and bronchopulmonary
dysplasia between the two groups of newborns (all P＞0.05). Compared with the successful ventilation group, the FiO2 ≥ 0.30
within 2 hours after birth and lactic acid value continued to increase obviously more in the ventilation failure group (all P＜
0.05). Conclusion The noninvasive ventilation strategy with NIPPV combined with NCPAP is safe for neonatal respiratory
distress syndrome, which is effective and worth promoting.  

Key words: respiratory distress syndrome, newborn, intermittent positive-pressure ventilation, continuous positive airway pressure, lactic acid

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