双水平气道正压通气在早产儿轻度呼吸窘迫综合征的应用及对早期肺功能的影响
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摘要
目的探讨双水平气道正压通气(BiPAP)治疗早产儿轻度呼吸窘迫综合征(RDS)的临床疗效及对患儿早期肺功能的影响,为BiPAP应用于早产儿轻度RDS的治疗提供临床参考。方法选择2016年6月-2018年1月安徽医科大学第三附属医院新生儿重症监护室(NICU)收治的76例早产儿轻度RDS为观察对象,生后即予无创呼吸支持,随机分为BiPAP组(38例)与持续气道正压通气(CPAP)组(38例),比较两组无创模式治疗早产儿RDS的治疗效果及对早期肺功能的影响情况。结果 1)与CPAP组比较,BiPAP组气管插管率明显降低(5.26%vs.26.32%,P<0.05),但平均无创通气时间、平均氧依赖时间、肺泡表面活性物质(PS)的重复应用、各种并发症的发生率、死亡率及平均住院时间的差异均无统计学意义(P>0.05);2)早期潮气肺功能参数中,与CPAP组比较,BiPAP组呼吸频率明显降低[(42.98±4.26)次/min vs.(46.13±4.58)次/min]、潮气量明显升高[(6.50±1.29)ml/kg vs.(5.55±1.03)ml/kg]、每分通气量明显增加[(0.50±0.66)L/(min·kg)vs.(0.45±0.47)L/(min·kg)](P<0.05),而达峰时间比、达峰容积比、呼气峰流速及75%、50%、25%潮气量时呼气流速差异无统计学意义(P>0.05)。结论与CPAP相比,BiPAP治疗早产儿轻度RDS更加安全有效,同时可提高肺的顺应性,改善患儿早期肺功能。
Objective To explore the efficacy and effect of Bi-level continuous positive airway pressure(BiPAP)on early pulmonary function in the treatment of premature infants with mild respiratory distress syndrome(RDS). Methods Totally 76 preterm infants with mild RDS in Neonatal Intensive Care Unit(NICU)of the Third Affiliated Hospital of Anhui Medical University were selected as participants from June 2016 to January 2018 and given non-invasive ventilation after birth.The infants were randomly divided into BiPAP group(38 cases)and CPAP group(38 cases).The therapeutic effect and early pulmonary function of the two groups were compared. Results 1)The endotracheal intubation rate of the BiPAP group was significantly lower than that of the CPAP group(5.26% vs.26.32%,P<0.05),but the average duration for noninvasive respiratory support,the average time of complementary oxygen need,repeated application of pulmonary surfactant,other complications,the death rate and the average hospitalization days between the two groups were not significantly different(P>0.05).2)The BiPAP group had significantly lower respiratory rate[(42.98±4.26)times/min vs.(46.13±4.58)times/min],higher tidal volume[(6.50±1.29)ml/kg vs.(5.55±1.03)ml/kg]and minute ventilation[(0.50±0.66)L/(min·kg)vs.(0.45±0.47)L/(min·kg)](P<0.05),while the differences on the ratio of time to peak tidal expiratory flow to total expiratory time,ratio of volume to peak tidal expiratory flow to total expiratory volume,peak expiratory flow,and breathing flow at 75%,50%,and 25%of tidal volume were not significant in both groups(P>0.05). Conclusion Compared with CPAP,BiPAP is safer and more effective in the treatment of mild RDS in preterm infants,and can also improve lung compliance and early lung function in preterm infants with RDS.
Objective To explore the efficacy and effect of Bi-level continuous positive airway pressure(BiPAP)on early pulmonary function in the treatment of premature infants with mild respiratory distress syndrome(RDS). Methods Totally 76 preterm infants with mild RDS in Neonatal Intensive Care Unit(NICU)of the Third Affiliated Hospital of Anhui Medical University were selected as participants from June 2016 to January 2018 and given non-invasive ventilation after birth.The infants were randomly divided into BiPAP group(38 cases)and CPAP group(38 cases).The therapeutic effect and early pulmonary function of the two groups were compared. Results 1)The endotracheal intubation rate of the BiPAP group was significantly lower than that of the CPAP group(5.26% vs.26.32%,P<0.05),but the average duration for noninvasive respiratory support,the average time of complementary oxygen need,repeated application of pulmonary surfactant,other complications,the death rate and the average hospitalization days between the two groups were not significantly different(P>0.05).2)The BiPAP group had significantly lower respiratory rate[(42.98±4.26)times/min vs.(46.13±4.58)times/min],higher tidal volume[(6.50±1.29)ml/kg vs.(5.55±1.03)ml/kg]and minute ventilation[(0.50±0.66)L/(min·kg)vs.(0.45±0.47)L/(min·kg)](P<0.05),while the differences on the ratio of time to peak tidal expiratory flow to total expiratory time,ratio of volume to peak tidal expiratory flow to total expiratory volume,peak expiratory flow,and breathing flow at 75%,50%,and 25%of tidal volume were not significant in both groups(P>0.05). Conclusion Compared with CPAP,BiPAP is safer and more effective in the treatment of mild RDS in preterm infants,and can also improve lung compliance and early lung function in preterm infants with RDS.
引文
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[15] O′Brien K,Campbell C,Brown L,et al.Infant flow biphasic nasal continuous positive airway pressure(BP-NCPAP)vsinfant flow NCPAP for the facilitation of extubation in infants′≤1250grams:a randomized controlled trial[J].BMC Pediatr,2012,12:43.
[16]戴立英,张健,王琍琍.双水平正压通气在早产儿呼吸窘迫综合征治疗中的应用[J].临床儿科杂志,2014,32(8):732-735.
[17]林报忠,郑通喜,蒋波,等.肺表面活性物质联合双水平气道正压通气治疗新生儿呼吸窘迫综合征的临床疗效[J].实用心脑肺血管病杂志,2017,25(7):77-80.
[18] Aguiar T,Macedo I,Voutsen O,et al.Nasal bilevel versus continuous positive airway pressure in preterm infants:a randomized controlled trial[J].Journal Clinical Trials,2015,5:3.
[19] Ricotti A,Salvo V,Zimmermann LJI,et al.N-SIPPV versus bi-level N-CPAP for early treatment of respiratory distress syndrome in preterm infants[J].Matern Fetal Neonatal Med,2013,26(13):1346-1351.
[20] Mphil DMG,Mcur LW,Btech AA,et al.Lung function in African infants:apilot study[J].Pediatric Pulmonology,2015,50(1):49-54.
[21] Nguyen TT,Hoo AF,Lum S,et al.New reference equations to improve interpretation of infant lung function[J].Pediatric Pulmonology,2013,48(4):370-380.
[22] Vrijlandt EJ,Kerstjens JM,Duiverman EJ,et al.Moderately preterm children have more respiratory problems during their first 5years of life than children born full term[J]. Am J Pespir Crit Care Med,2013,187(11):1234-1240.
[23]朱洪斌,高彩云,闫爱霞,等.nBiPAP和nCPAP治疗早产儿呼吸暂停疗效比较及对患儿肺功能和Gesell评分的影响[J].临床肺科杂志,2018,23(1):73-78.
[24] Ishihara C,Ibara S,Ohsone Y,et al.Effects of infant flow Bi-NCPAP on apnea of prematurity[J].Pediatr Int,2016,58(6):456-460.
[25] Lampland AL,Plumm B,Worwa C,et al.Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome[J].Arch Dis Child Fetal Neonatal Ed,2015,100(1):F31-F34.
[2] Jeon GW.Respiratory support with heated humidified high flow nasal cannula in preterm infants[J].Korean Pediatr,2016,59(10):389-394.
[3] Schm9zer GM,Kumar M,Pichler G,et al.Non-invasive versus invasive respiratory support in preterm infants at birth:systematic review and meta-analysis[J].BMJ,2013,347:f5980.
[4] Fischer HS,Bührer C.Avoiding endotracheal ventilation to prevent bronchopulmonary dysplasia a meta-analysis[J].Pediatrics,2013,132(5):e1351-e41360.
[5]邵肖梅,叶鸿瑁,丘小汕.实用新生儿学[M].4版.北京:人民卫生出版社,2011:395-397.
[6] Sadeghnia A,Barekateyn B,Badiei Z,et al.Analysis and comparison of the effects of N-BiPAP and in Bubble-CPAP treatment of preterm newborns with the weight of below1500grams affiliated with respiratory distress syndrome:a randomised clinical trial[J].Adv Biomed Res,2016,5:3.
[7]Migliori C,Motta M,Angeli A,et al.Nasal bilevel vs.continuous positive airway pressure in preterm infants[J].Pediatr Pulmonol,2005,40(5):426-430.
[8] Salvo V,Lista G,Lupo E,et al.Noninvasive ventilation strategies for early treatment of RDS in preterm infants:an RCT[J].Pediatrics,2015,135(3):444-451.
[9]中华医学会儿科学分会呼吸学组肺功能协作组.儿童肺功能系列指南(四):潮气呼吸肺功能[J].中华实用儿科临床杂志,2016,31(21):1617-1621.
[10] Sweet DG,Carnielli V,Greisen G,et al.European consensus guidelines on the management of respiratory distress syndrome-2016update[J].Neonatology,2017,111:107-125.
[11] Rojas MA,Lozano JM,Rojas MX,et al.Very early surfactant without mandatory ventilation in premature infants treated with early continuous positive airway pressure:a randomized,controlled trial[J].Pediatrics,2009,123(1):137-142.
[12] Kieran EA,Walsh H,O′Donnell CPF.Survey of nasal continuous positive airways pressure(NCPAP)and nasal intermittent positive pressure ventilation(NIPPV)use in Irish newborn nurseries[J].Arch Dis Child Fetal Neonatal Ed,2011,96:F156.
[13]Morley SL.Non-invasive ventilation in paediatric critical care.[J].Paediatr Respir Rev,2016,20:24-31.
[14] Lista G,Castoldi F,Fontana P,et al.Nasal continuous positive airway pressure(CPAP)versus bi-level nasal CPAP in preterm babies with respiratory distress syndrome:a randomised control trial[J].Arch Dis Child Fetal Neonatal Ed,2010,95(2):85-89.
[15] O′Brien K,Campbell C,Brown L,et al.Infant flow biphasic nasal continuous positive airway pressure(BP-NCPAP)vsinfant flow NCPAP for the facilitation of extubation in infants′≤1250grams:a randomized controlled trial[J].BMC Pediatr,2012,12:43.
[16]戴立英,张健,王琍琍.双水平正压通气在早产儿呼吸窘迫综合征治疗中的应用[J].临床儿科杂志,2014,32(8):732-735.
[17]林报忠,郑通喜,蒋波,等.肺表面活性物质联合双水平气道正压通气治疗新生儿呼吸窘迫综合征的临床疗效[J].实用心脑肺血管病杂志,2017,25(7):77-80.
[18] Aguiar T,Macedo I,Voutsen O,et al.Nasal bilevel versus continuous positive airway pressure in preterm infants:a randomized controlled trial[J].Journal Clinical Trials,2015,5:3.
[19] Ricotti A,Salvo V,Zimmermann LJI,et al.N-SIPPV versus bi-level N-CPAP for early treatment of respiratory distress syndrome in preterm infants[J].Matern Fetal Neonatal Med,2013,26(13):1346-1351.
[20] Mphil DMG,Mcur LW,Btech AA,et al.Lung function in African infants:apilot study[J].Pediatric Pulmonology,2015,50(1):49-54.
[21] Nguyen TT,Hoo AF,Lum S,et al.New reference equations to improve interpretation of infant lung function[J].Pediatric Pulmonology,2013,48(4):370-380.
[22] Vrijlandt EJ,Kerstjens JM,Duiverman EJ,et al.Moderately preterm children have more respiratory problems during their first 5years of life than children born full term[J]. Am J Pespir Crit Care Med,2013,187(11):1234-1240.
[23]朱洪斌,高彩云,闫爱霞,等.nBiPAP和nCPAP治疗早产儿呼吸暂停疗效比较及对患儿肺功能和Gesell评分的影响[J].临床肺科杂志,2018,23(1):73-78.
[24] Ishihara C,Ibara S,Ohsone Y,et al.Effects of infant flow Bi-NCPAP on apnea of prematurity[J].Pediatr Int,2016,58(6):456-460.
[25] Lampland AL,Plumm B,Worwa C,et al.Bi-level CPAP does not improve gas exchange when compared with conventional CPAP for the treatment of neonates recovering from respiratory distress syndrome[J].Arch Dis Child Fetal Neonatal Ed,2015,100(1):F31-F34.
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