经鼻间歇正压通气治疗新生儿呼吸窘迫综合征的随机对照研究

发布时间：2018-04-29 07:40

  本文选题：新生儿 + 呼吸窘迫综合征　； 参考：《安徽医科大学》2012年硕士论文

【摘要】：[目的] 比较经鼻间歇正压通气(NIPPV)与经鼻持续气道正压通气(NCPAP)在新生儿呼吸窘迫综合征(NRDS)中的疗效。 [方法] 采用随机对照(RCT)研究的方法,选择2011年3月至2012年2月在蚌埠医学院第一附属医院新生儿重症监护病房(NICU)住院的NRDS患儿作为研究对象。入选标准：(1)胎龄37周；(2)符合NRDS诊断标准,即生后不久出现呼吸窘迫如紫绀、呻吟、三凹征和呼吸急促,可进一步发展为呼吸衰竭；同时具备肺部X线典型表现如毛玻璃样改变、支气管充气征和白肺等。排除标准：(1)严重先天性畸形、胎粪吸入及感染,(2)重症呼吸性酸中毒(PaC0260mmHg, NIPPV或NCPAP治疗前),(3)结局不明的病例,(4)无需或拒签知情同意书使用呼吸机治疗的病例。将研究对象随机分为NIPPV组和NCPAP组,分别实施NIPPV和NCPAP干预,观察两组动脉血气分析、氧合指数(O工)、呼吸支持时间及并发症等指标,比较NIPPV组和NCPAP组治疗成功率、预后良好率、支气管肺发育不良(BPD)发生率及死亡率等结局指标。采用SPSS13.0统计软件对数据进行分析。计量资料用均数±标准差(x±s)表示,行t(或t’)检验,计数资料的比较采用χ2检验,P0.05差异有统计学意义。 [结果] 1.一般情况：实际纳入研究对象62例,其中NIPPV组32例,NCPAP组30例。两组患儿在性别、胎龄、出生体重、年龄、生后5min Apgar评分、新生儿急性生理学评分围产期补充Ⅱ (SNAPPE-Ⅱ)评分、肺表面活性物质(PS)使用率、治疗前动脉血气分析和0I等方面差异无统计学意义(P均0.05)。 2.疗效比较 (1)血气分析及OI:NIPPV组治疗后1h PaO2、OI显著高于NCPAP组(P均0.05)。 (2)治疗成功率及呼吸支持时间：NIPPV组治疗成功率为68.8%(22/32),NCPAP组为40.0%(12/30),NIPPV组显著高于NCPAP组(P0.05)。NIPPV组和NCPAP组无创通气治疗时间和经气管插管机械通气时间差均无统计学意义(P均0.05)。 3.并发症：两组共有3例气胸发生,NIPPV组1例(3.1%),NCPAP组2例(6.7%),均发生在气管插管机械通气阶段。两组气胸发生率无统计学差异(P0.05)。 4.预后：NIPPV组预后良好率为78.1%(25/32),NCPAP组为66.7%(20/30),两组差异无统计学意义(P0.05)。NIPPV组BPD发生率为9.4%(3/32),NCPAP组为13.3%(4/30),两组差异无统计学意义(P0.05)。 NIPPV组死亡率为12.5%(4/32),NCPAP组为20.0%(6/30),两组差异亦无统计学意义(P0.05)。 [结论] 与NCPAP相比,NIPPV可显著降低NRDS早产儿行气管插管机械通气的比例。但现有研究尚不能证实NIPPV可显著降低BPD和死亡的发生率。有关NIPPV对NRDS的远期疗效仍有待大规模、多中心的RCT研究予以明确。
[Abstract]:[purpose] To compare the efficacy of nasal intermittent positive pressure ventilation (NIPPVV) and transnasal continuous positive airway pressure ventilation (NCPAP) in neonatal respiratory distress syndrome (NRDS). [methods] A randomized controlled RCT study was conducted to study the NRDS patients hospitalized in the Neonatal intensive Care Unit (NICU) of the first affiliated Hospital of Bengbu Medical College from March 2011 to February 2012. Admission criteria: 1) gestational age 37 weeks / 2) conforms to NRDS diagnostic criteria, i.e. respiratory distress, such as cyanosis, groan, concave sign and shortness of breath, can develop further into respiratory failure shortly after birth; at the same time, it has typical lung X-ray manifestations such as glass-like changes. Bronchi inflatable sign and white lung etc. Exclusion criteria: 1) severe congenital malformation, meconium aspiration and infection 2) severe respiratory acidosis with PaC0260mm Hg, NIPPV or NCPAP before treatment) patients with unknown outcome (no need or refusal to sign informed consent to be treated with ventilator. The subjects were randomly divided into NIPPV group and NCPAP group. NIPPV and NCPAP intervention were performed respectively. Arterial blood gas analysis, oxygenation index, respiratory support time and complications were observed in the two groups. The success rate and prognosis of NIPPV group and NCPAP group were compared. Bronchopulmonary dysplasia (BPD) incidence and mortality and other outcome indicators. The data were analyzed by SPSS13.0 software. The measurement data were expressed as mean 卤standard deviation (x 卤s). T (or t0) test was performed. There was statistical significance in the comparison of counting data by 蠂 2 test (P0.05). [results] 1. General situation: 62 cases were included in the study, including 32 cases in NIPPV group and 30 cases in NCPAP group. Sex, gestational age, birth weight, age, postnatal 5min Apgar score, neonatal acute physiology score, perinatal supplement 鈪，

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