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两种无创呼吸支持治疗极低出生体重儿呼吸窘迫综合征疗效分析
王柱, 向建文, 高薇薇, 沈永珍, 周文姬, 陈佳, 许芳, 杨杰
中国当代儿科杂志 ›› 2018, Vol. 20 ›› Issue (8) : 603-607.
PDF(1117 KB)
PDF(1117 KB)
两种无创呼吸支持治疗极低出生体重儿呼吸窘迫综合征疗效分析
Comparison of clinical efficacy of two noninvasive respiratory support therapies for respiratory distress syndrome in very low birth weight preterm infants
目的 探讨早期应用经鼻间歇正压通气（NIPPV）与加温湿化经鼻导管高流量通气（HHHFNC）治疗极低出生体重呼吸窘迫综合征（RDS）早产儿的临床疗效。方法 89例极低出生体重RDS早产儿依据初始呼吸支持治疗方式随机分为NIPPV组（46例）和HHHFNC组（43例）。分析两组患儿初始治疗失败率、肺表面活性物质（PS）使用率、呼吸支持治疗相关数据及各种并发症的发生率。结果 NIPPV组治疗72 h内气管插管率、PS使用率、有创辅助通气时间、无创辅助通气时间及总用氧时间、严重呼吸暂停发生率、肺炎发生率与HHHFNC组的差异无统计学意义（P > 0.05）；NIPPV组支气管肺发育不良、颅内出血、早产儿视网膜病、坏死性小肠结肠炎、动脉导管未闭、气漏的发生率与HHHFNC组的差异均无统计学意义（P > 0.05）；NIPPV组鼻损伤的发生率高于HHHFNC组（P < 0.05）。结论 对于极低出生体重RDS早产儿的初始呼吸支持治疗，HHHFNC与NIPPV疗效相当，是可供临床选择的另一种安全和有效的无创辅助通气治疗方式。
Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation (NIPPV) and heated humidified high flow nasal cannula (HHHFNC) in the treatment of respiratory distress syndrome (RDS) among very low birth weight (VLBW) preterm infants.Methods A total of 89 very low birth weight premature infants with respiratory distress syndrome (RDS) who were randomly administered with NIPPV (n=46) and HHHFNC (n=43) as an initial respiratory support. The incidence of initial treatment failure, the usage of pulmonary surfactant (PS), the parameters of respiratory support treatment and the incidence of complications were compared between the two groups.Results There were no significant differences between the NIPPV and HHHFNC groups in the following items:the rate of intubation within 72 hours, rate of PS use, duration of invasive or non-invasive mechanical ventilation, duration of oxygen therapy, and incidence rates of severe apnea and pneumonia (P > 0.05). There were also no significant differences in the incidence rates of bronchopulmonary dysplasia, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, intracranial hemorrhage, and air leak between the two group (P > 0.05). The incidence rate of nose injury in the NIPPV group was higher than that in the HHHFNC group (P < 0.05).Conclusions As an initial respiratory support for very low birth weight preterm infants with RDS, HHHFNC has a similar clinical effect as NIPPV, suggesting that HHHFNC is a safe and effective clinical option as a non-invasive ventilation treatment.
呼吸窘迫综合征 / 经鼻间歇正压通气 / 经鼻导管高流量通气 / 极低出生体重儿
Respiratory distress syndrome / Intermittent positive pressure ventilation / High flow nasal cannula / Very low birth weight infant
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