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目的探讨经鼻同步间歇正压通气(nasal synchronized intermittent positive pressure ventilation,NSIPPV)治疗新生儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)的治疗效果。方法胎龄≤32周NRDS患儿68例,随机分为NSIPPV治疗组(观察组)和持续经鼻正压通气治疗组(对照组)各34例,分别于入院0、2、12、24、36h进行血气分析,比较氧合情况,并记录无创辅助通气时间、插管机械通气率、肺气漏等发生情况。结果 2组治疗后2h,pa(O2)及pa(CO2)均优于治疗前,但2组间比较差异无统计学意义(P>0.05);治疗后12、24及36h,观察组pa(O2)高于对照组、pa(CO2)低于对照组,2组比较差异有统计学意义(P<0.05),且同一时间点,观察组吸氧浓度及呼吸末正压均低于对照组(P<0.05);观察组无创辅助通气时间、插管机械通气率等指标优于对照组(P<0.05),无创辅助通气时间明显减少(P<0.05)。结论 NSIPPV模式治疗胎龄≤32周的NRDS更有利于肺部氧合,可缩短患儿无创通气时间、降低插管机械通气率。
Objective To investigate the therapeutic effect of nasal synchronized intermittent positive pressure ventilation (NSIPPV) on neonatal respiratory distress syndrome (NRDS). Methods 68 cases of NRDS children with gestational age ≤32 weeks were randomly divided into NSIPPV treatment group (observation group) and continuous nasal positive pressure ventilation treatment group (control group), 34 cases were admitted to hospital for 0, 2, 12, 24, 36h blood gas analysis, comparison of oxygenation, and record non-invasive auxiliary ventilation time, intubation mechanical ventilation rate, pulmonary air leakage and so on. Results After 2 hours of treatment, pa (O2) and pa (CO2) were better than those before treatment, but there was no significant difference between the two groups (P> 0.05). At 12, 24 and 36 hours after treatment, pa O2) was higher than the control group, Pa (CO2) was lower than the control group, the difference was statistically significant (P <0.05), and the same time point, the observation group oxygen concentration and positive end-expiratory pressure were lower than the control group (P <0.05). The indexes of non-invasive auxiliary ventilation and intubation mechanical ventilation in the observation group were better than those in the control group (P <0.05), and the time of noninvasive auxiliary ventilation was significantly decreased (P <0.05). Conclusion NSIPPV treatment of NRDS with gestational age less than 32 weeks is more beneficial to pulmonary oxygenation, which can shorten the duration of non-invasive ventilation and reduce the mechanical ventilation rate of intubation.