微创医学

目的比较经鼻持续气道正压通气（NCPAP）、经鼻间歇正压通气（NIPPV）、经鼻加温湿化高流量氧疗（HFNC）在早产儿呼吸窘迫综合征（RDS）初始治疗中的应用效果。方法选择198例RDS的早产儿为研究对象，利用随机数字表法将患儿随机分为NCPAP组（n=65）、NIPPV组（n=61）和HFNC组（n=72），分别给予3种无创通气模式（NCPAP、NIPPV、HFNC）治疗。比较各组患儿使用无创通气呼吸支持后24 h血气分析pH值、动脉血二氧化碳分压（PaCO2）、呼吸指数（RI）、氧合指数（P/F）等参数，比较各组患儿吸入氧浓度（FiO2）、无创通气使用时间、不良反应及远期并发症等情况，通过多因素Logistic回归分析法探讨无创通气失败的相关因素。结果治疗前，3组患儿的血气分析pH值、PaCO2值比较，差异均无统计学意义（均P＞0.05）；治疗后，3组患儿血气分析pH值差异无统计学意义（P＞0.05），HFNC组患儿的血气分析PaCO2水平明显高于NCPAP组和NIPPV组（均P＜0.05）。HFNC组患儿的RI值、24 h FiO2值明显高于NCPAP组和NIPPV组，P/F值低于NCPAP组和NIPPV组（均P＜0.05）。NIPPV组患儿的P/F值高于NCPAP组，24 h FiO2值低于NCPAP组（均P＜0.05）。3组RDS患儿在无创通气持续时间、无创通气失败改有创通气率、相关并发症发生率方面比较，差异均无统计学意义（均P＞0.05）。多因素Logistic回归分析结果显示，无创通气模式和RDS分级是无创通气失败的独立影响因素。结论 NCPAP或NIPPV通气模式在治疗中提高早产儿RDS氧合、减少CO2潴留等方面优于HFNC，通气模式的选择及RDS严重程度是无创通气治疗失败的独立影响因素。

Objective To compare the application effect of nasal continuous positive airway pressure (NCPAP), nasal intermittent positive pressure ventilation (NIPPV) and high-flow nasal cannula oxygen therapy (HFNC) in the initial treatment of premature infants with respiratory distress syndrome (RDS). Methods A total of 198 premature infants with RDS were randomly divided into NCPAP group (n=65), NIPPV group (n=61) and HFNC group (n=72), and three non-invasive ventilation modes (NCPAP, NIPPV and HFNC) were given respectively. The parameters of blood gas analysis such as pH value, arterial partial pressure of carbon dioxide (PaCO2), respiratory index (RI) and partial pressure of oxygen in arterial blood/fractional concentration of inspiratory oxygen (P/F) were compared among the groups at 24 hours after non-invasive ventilation. The fraction of inspiratory oxygen (FiO2), duration of non-invasive ventilation, adverse reactions and long-term complications were compared among the groups, and the related factors of non-invasive ventilation failure were researched by multivariate Logistic regression analysis. Results Before treatment, there was no statistically significant difference in pH value and PaCO2 value in blood gas analysis among the three groups (all P＞0.05). After treatment, there was no statistically significant difference in pH value in blood gas analysis among the three groups (P>0.05), and the PaCO2 level of blood gas analysis in the HFNC group was significantly higher than that in the NCPAP group and NIPPV group (all P＜0.05). The RI value and 24 h FiO2 value in the HFNC group were significantly higher than those in the NCPAP group and NIPPV group, while the P/F value was lower than that in the NCPAP group and NIPPV group (all P＜0.05). Compared with NCPAP group, the P/F value was higher and the 24 h FiO2 value was lower in the NIPPV group (all P＜0.05). There were no statistically significant differences in the duration of non-invasive ventilation, the rate of conversion from non-invasive ventilation failure to invasive ventilation, and the incidence of related complications among the three groups (all P＞0.05). The results of multivariate Logistic regression analysis showed that non-invasive ventilation mode and RDS grade were independent influencing factors for the failure of non-invasive ventilation. Conclusion NCPAP or NIPPV is superior to HFNC in improving oxygenation and reducing CO2 retention in premature infants with RDS. The choice of ventilation mode and the severity of RDS are independent influencing factors for the failure of non-invasive ventilation.