|摘要||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.
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.|