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目的探讨经鼻间歇正压通气(NIPPV)对新生儿呼吸窘迫综合征(RDS)的临床价值。方法选择本院新生儿重症监护病房2008年2月至2010年8月收住的RDS患儿,2009年5月之前的患儿应用肺表面活性物质(PS)后予以经鼻持续气道正压通气(NCPAP)治疗,之后的患儿应用PS后予以NIPPV,比较两组治疗成功率、血气变化、氧疗时间、并发症及住院费用。结果两组患儿基本情况和RDS分级差异无统计学意义(P均>0.05)。NIPPV组47例,治疗RDS成功率91.5%,明显高于NCPAP组的成功率73.3%,差异有统计学意义(P<0.05)。NIPPV组治疗后1 h的PaCO2比NCPAP组改善更明显,两组比较差异有统计学意义(P<0.05)。NIPPV组治疗后12 h的pH、PaCO2、PaO2优于NCPAP组[pH:(7.38±0.10)比(7.33±0.08),PaCO2:(32.5±8.9)mm Hg比(38.3±9.4)mm Hg,PaO2:(78.5±15.2)mm Hg比(70.4±13.2)mm Hg,P均<0.01]。NIPPV组氧疗时间短于NCPAP组,支气管肺发育不良发生率(12.8%)低于NCPAP组(33.3%),住院费用少于NCPAP组,差异有统计学意义(P<0.05)。结论 NIPPV治疗RDS疗效优于NCPAP。
Objective To investigate the clinical value of nasal intermittent positive pressure ventilation (NIPPV) on neonatal respiratory distress syndrome (RDS). Methods RDS children admitted to our neonatal intensive care unit from February 2008 to August 2010 were enrolled in this study. Patients with pre-May 2009 pulmonary surfactant (PS) and nasal continuous positive airway pressure (NCPAP). Afterwards, the patients were treated with NIPPV after PS. The success rate of treatment, blood gas changes, oxygen therapy time, complications and hospitalization costs were compared between the two groups. Results There was no significant difference between the two groups in the basic situation and RDS grading (all P> 0.05). In the 47 cases of NIPPV group, the success rate of treatment of RDS was 91.5%, which was significantly higher than that of NCPAP group (73.3%), the difference was statistically significant (P <0.05). PaCO2 improved more significantly in NIPPV group than in NCPAP group at 1 hour after treatment, with significant difference between the two groups (P <0.05). PaCO2: PaCO2: (32.5 ± 8.9) mmHg (38.3 ± 9.4) mmHg, PaO2 (PaO2: PaO2) were significantly higher in the NIPPV group than those in the NCPAP group at 12 h : (78.5 ± 15.2) mm Hg (70.4 ± 13.2) mm Hg, P <0.01]. The duration of oxygen therapy in NIPPV group was shorter than that in NCPAP group. The incidence of bronchopulmonary dysplasia (12.8%) was lower than that of NCPAP group (33.3%) and hospitalization expense was lower than that of NCPAP group (P <0.05). Conclusion NIPPV is superior to NCPAP in the treatment of RDS.