两种无创正压给氧方式对呼吸窘迫综合征早产儿血气指标及疗效影响的比较

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摘要目的: 比较两种无创正压给氧方式对早产儿呼吸窘迫综合征血气指标及疗效的影响。方法: 随机选择78例呼吸窘迫综合征早产儿，按随机数字表法分为两组（n＝39）。一组采用鼻塞式持续气道正压通气（nasal continuous positive airway pressure，NCPAP）模式治疗（NCPAP组）；另一组采用双水平气道正压通气（bilevel positive airway pressure,BiPAP）模式治疗（BiPAP组）。采集患儿桡动脉血，比较两组患儿治疗0、6、12、24 h的通气模式工作参数［呼吸末正压通气（PEEP）/呼吸压力（EPAP）、吸入氧浓度（FiO2）］及治疗前、后的血气指标（PaO2、PaCO2、pH、SaO2），并统计治疗24 h后的治疗有效率及不良反应发生率。结果：两组患儿治疗前通气模式的工作参数无明显差异（P＞0.05）；治疗后6、12、24 h，两组患儿通气模式的工作参数均明显降低；相同治疗时段对比，BiPAP组的通气参数均明显低于NCPAP组（均P＜0.05）。两组患儿治疗前PaCO2、PaO2、pH及SaO2均无明显差异（均P＞0.05）；治疗后，两组患儿血气指标均明显改善，但BiPAP组改善显著优于NCPAP组（均P＜0.05）。BiPAP组治疗有效率为92.31%（36/39），明显高于NCPAP组［74.36%（29/39），P＜0.05］。BiPAP组肺部不良反应发生率为5.13%（2/39），明显低于NCPAP组［20.51%（8/39），P＜0.05］。结论： BiPAP模式治疗早产儿呼吸窘迫综合征，比NCPAP模式氧合作用高，CO2滞留减少，治疗效果有所提高，且能减少不良反应的发生。

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关键词 ：无创正压给氧, 呼吸窘迫综合征, 血气指标, 早产儿

Abstract：Objective: To compare the effects of two noninvasive positive pressure oxygen feeding methods on the improvement of blood gas index and the therapeutic efficacy of premature infants with respiratory distress syndrome. Methods: A total of 78 premature infants with respiratory distress syndrome were randomly divided into the control group and the observation group, each group with 39 cases. The control group was treated with nasal continuous positive airway pressure(NCPAP), and the observation group was treated with bilevel positive airway pressure(BiPAP).The working parameters(PEEP/EPAP, FiO2) and blood gas index(PaO2, pH, PaCO2, SaO2) after treatment of 0, 6,12 and 24 h were compared, the efficiency and side effects after 24 h treatment of were recorded. Results: Before treatment, there was no significant difference between the 2 groups in working parameters of ventilation mode(P>0.05); 6, 12, 24 h after treatment, ventilation mode parameters of 2 groups were significantly timedependent decreased; the ventilation parameters of the observation group was significantly lower than those of the control group at the same treatment time, the difference reaches statistical significance(P<0.05). Before treatment, blood gas index PaCO2, PaO2, pH and SaO2 showed no significant difference between the 2 groups(P>0.05); after treatment, the arterial blood gas of the 2 groups were improved significantly, but the arterial blood gas were much more improved in the observation group than those of the control group(P<0.05).The effective rate of the observation group was 92.31%(36/39),significantly higher than that of the control group\[74.36%(29/39),P<0.05\].The incidence of adverse reactions of the lungs in the observation group was 5.13%(2/39), significantly lower than that in the control group\[20.51%(8/39), P<0.05\]. Conclusion: The BiPAP had higher oxygenation than the NCPAP, and lower the retention of CO2, and improved the therapeutic effect of the children and reduced the adverse reactions.

收稿日期: 2017-09-27

基金资助:

池州市科技计划项目（zc09009）

作者简介: 黄玮（1983—），男，安徽怀宁人，主治医师，主要从事新生儿疾病诊治研究。

引用本文:

黄玮，许东宝，吴超华，汪浩文，祝选姣，胡海英. 两种无创正压给氧方式对呼吸窘迫综合征早产儿血气指标及疗效影响的比较[J]. 江苏大学学报:医学版, 2018, 28(01): 75-78. HUANG Wei, XU Dong-bao, WU Chao-hua, WANG Hao-wen, ZHU Xuan-jiao, HU Hai-ying. Comparison the effects of two noninvasive positive pressure oxygen feeding methods on the improvement of blood gas index and the therapeutic efficacy of premature infants with respiratory distress syndrome. Journal of Jiangsu University(Medicine Edition), 2018, 28(01): 75-78.

链接本文:

http://zzs.ujs.edu.cn/xbyxb/CN/ 或 http://zzs.ujs.edu.cn/xbyxb/CN/Y2018/V28/I01/75

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