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目的比较双水平气道正压通气( BiPAP) 和鼻塞式持续气道正压通气( NCPAP) 联合肺表面活性物质( PS) 在早产儿呼吸窘迫综合征( RDS) 中的应用效果。方法选择本科 2009年2月至 2012年2月收治的 80 例 RDS 早产儿,常规使用 PS 进行替代治疗后,随机分入 BiPAP 通气模式组( BiPAP 组) 和 NCPAP 通气模式组( NCPAP 组) ,每组各 40 例。观察两组工作参数、氧动力学指标、正压通气时间、氧疗时间、治疗成功率及气胸、支气管肺发育不良、早产儿视网膜病等并发症的发生率。结果 ( 1) 两组通气模式工作参数: 吸入氧浓度( FiO2) 、呼气末正压/呼气相正压( PEEP/EPAP) 均随通气时间延长逐渐降低,0 h( 上机时) 差异无统计学意义( P > 0. 05) ,上机后6 h、12 h、24 h、48 h BiPAP 组 FiO2、PEEP/EPAP 均低于 NCPAP 组,差异有统计学意义( P <0. 05 或0. 01) 。( 2) 两组均能保持较好的氧分压( PaO2) 、动脉血氧分压/吸入氧浓度比值( P/F) 、动脉/肺泡氧分压比值( PaO2/ PAO2) ,且均有上升趋势,二氧化碳分压( PaCO2) 呈降低趋势,两组在0 h 时各指标差异均无统计学意义( P >0. 05) ,BiPAP 组上机后 6 h、12 h、24 h、48 h PaO2、P/F、PaO2/ PAO2均明显高于 NCPAP 组( P <0. 05 或 0. 01) ,PaCO2低于 NCPAP 组( P <0. 05) 。( 3) BiPAP 组通气时间、氧疗时间明显短于 NCPAP 组,治疗成功率高于 NCPAP 组( P <0. 05) 。( 4) 两组气胸、支气管肺发育不良、早产儿视网膜病发生率差异无统计学意义( P >0. 05) 。结论 BiPAP 联合 PS 治疗 RDS早产儿的疗效优于 NCPAP,其具有高效、安全等优点,值得推广。
Objective To compare the effects of bi-level positive airway pressure (BiPAP) and nasal continuous positive airway pressure (NCPAP) combined with pulmonary surfactant (PS) in respiratory distress syndrome (RDS) in preterm infants. Methods Eighty preterm infants with RDS admitted to our hospital from February 2009 to February 2012 were randomly assigned to receive either BiPAP ventilation or NCPAP ventilation (NCPAP) Group of 40 cases. The working parameters, oxygen dynamic indexes, positive pressure ventilation time, oxygen therapy time, the success rate of treatment and the incidence of complications such as pneumothorax, bronchopulmonary dysplasia and retinopathy of prematurity were observed. Results (1) The ventilatory parameters of two groups: FiO2, PEEP / EPAP decreased gradually with the prolongation of ventilation time, FiO2 and PEEP / EPAP in BiPAP group were lower than those in NCPAP group at 6 h, 12 h, 24 h and 48 h after on-line, the difference was statistically significant (P <0.05) Or 0.01). (2) PaO2, PaO2 / PO2 and PaO2 / PAO2 were well maintained in both groups, both of which had (PaCO2) showed a trend of decreasing. There was no significant difference in each index between two groups at 0 h (P> 0.05), while those in BiPAP group at 6 h, 12 h, 24 h, 48 hPaO2, P / F, PaO2 / PAO2 were significantly higher than those in NCPAP group (P <0.05 or 0.01), PaCO2 was lower than that in NCPAP group (P <0.05). (3) The ventilation time and oxygen therapy time of BiPAP group were significantly shorter than that of NCPAP group, and the success rate of treatment was higher than that of NCPAP group (P <0.05). (4) The two groups of pneumothorax, bronchopulmonary dysplasia, the incidence of retinopathy of prematurity was no significant difference (P> 0.05). Conclusions BiPAP combined with PS is superior to NCPAP in the treatment of premature infants with RDS, which has the advantages of high efficiency and safety and is worthy of popularization.