本文選題：新生兒 + 呼吸窘迫綜合征��； 參考：《安徽醫(yī)科大學》2012年碩士論文

【摘要】：[目的] 比較經鼻間歇正壓通氣(NIPPV)與經鼻持續(xù)氣道正壓通氣(NCPAP)在新生兒呼吸窘迫綜合征(NRDS)中的療效。 [方法] 采用隨機對照(RCT)研究的方法,選擇2011年3月至2012年2月在蚌埠醫(yī)學院第一附屬醫(yī)院新生兒重癥監(jiān)護病房(NICU)住院的NRDS患兒作為研究對象。入選標準：(1)胎齡37周；(2)符合NRDS診斷標準,即生后不久出現(xiàn)呼吸窘迫如紫紺、呻吟、三凹征和呼吸急促,可進一步發(fā)展為呼吸衰竭；同時具備肺部X線典型表現(xiàn)如毛玻璃樣改變、支氣管充氣征和白肺等。排除標準：(1)嚴重先天性畸形、胎糞吸入及感染,(2)重癥呼吸性酸中毒(PaC0260mmHg, NIPPV或NCPAP治療前),(3)結局不明的病例,(4)無需或拒簽知情同意書使用呼吸機治療的病例。將研究對象隨機分為NIPPV組和NCPAP組,分別實施NIPPV和NCPAP干預,觀察兩組動脈血氣分析、氧合指數(shù)(O工)、呼吸支持時間及并發(fā)癥等指標,比較NIPPV組和NCPAP組治療成功率、預后良好率、支氣管肺發(fā)育不良(BPD)發(fā)生率及死亡率等結局指標。采用SPSS13.0統(tǒng)計軟件對數(shù)據(jù)進行分析。計量資料用均數(shù)±標準差(x±s)表示,行t(或t’)檢驗,計數(shù)資料的比較采用χ2檢驗,P0.05差異有統(tǒng)計學意義。 [結果] 1.一般情況：實際納入研究對象62例,其中NIPPV組32例,NCPAP組30例。兩組患兒在性別、胎齡、出生體重、年齡、生后5min Apgar評分、新生兒急性生理學評分圍產期補充Ⅱ (SNAPPE-Ⅱ)評分、肺表面活性物質(PS)使用率、治療前動脈血氣分析和0I等方面差異無統(tǒng)計學意義(P均0.05)。 2.療效比較 (1)血氣分析及OI:NIPPV組治療后1h PaO2、OI顯著高于NCPAP組(P均0.05)。 (2)治療成功率及呼吸支持時間：NIPPV組治療成功率為68.8%(22/32),NCPAP組為40.0%(12/30),NIPPV組顯著高于NCPAP組(P0.05)。NIPPV組和NCPAP組無創(chuàng)通氣治療時間和經氣管插管機械通氣時間差均無統(tǒng)計學意義(P均0.05)。 3.并發(fā)癥：兩組共有3例氣胸發(fā)生,NIPPV組1例(3.1%),NCPAP組2例(6.7%),均發(fā)生在氣管插管機械通氣階段。兩組氣胸發(fā)生率無統(tǒng)計學差異(P0.05)。 4.預后：NIPPV組預后良好率為78.1%(25/32),NCPAP組為66.7%(20/30),兩組差異無統(tǒng)計學意義(P0.05)。NIPPV組BPD發(fā)生率為9.4%(3/32),NCPAP組為13.3%(4/30),兩組差異無統(tǒng)計學意義(P0.05)。 NIPPV組死亡率為12.5%(4/32),NCPAP組為20.0%(6/30),兩組差異亦無統(tǒng)計學意義(P0.05)。 [結論] 與NCPAP相比,NIPPV可顯著降低NRDS早產兒行氣管插管機械通氣的比例。但現(xiàn)有研究尚不能證實NIPPV可顯著降低BPD和死亡的發(fā)生率。有關NIPPV對NRDS的遠期療效仍有待大規(guī)模、多中心的RCT研究予以明確。
[Abstract]:[purpose] To compare the efficacy of nasal intermittent positive pressure ventilation (NIPPVV) and transnasal continuous positive airway pressure ventilation (NCPAP) in neonatal respiratory distress syndrome (NRDS). [methods] A randomized controlled RCT study was conducted to study the NRDS patients hospitalized in the Neonatal intensive Care Unit (NICU) of the first affiliated Hospital of Bengbu Medical College from March 2011 to February 2012. Admission criteria: 1) gestational age 37 weeks / 2) conforms to NRDS diagnostic criteria, i.e. respiratory distress, such as cyanosis, groan, concave sign and shortness of breath, can develop further into respiratory failure shortly after birth; at the same time, it has typical lung X-ray manifestations such as glass-like changes. Bronchi inflatable sign and white lung etc. Exclusion criteria: 1) severe congenital malformation, meconium aspiration and infection 2) severe respiratory acidosis with PaC0260mm Hg, NIPPV or NCPAP before treatment) patients with unknown outcome (no need or refusal to sign informed consent to be treated with ventilator. The subjects were randomly divided into NIPPV group and NCPAP group. NIPPV and NCPAP intervention were performed respectively. Arterial blood gas analysis, oxygenation index, respiratory support time and complications were observed in the two groups. The success rate and prognosis of NIPPV group and NCPAP group were compared. Bronchopulmonary dysplasia (BPD) incidence and mortality and other outcome indicators. The data were analyzed by SPSS13.0 software. The measurement data were expressed as mean 鹵standard deviation (x 鹵s). T (or t0) test was performed. There was statistical significance in the comparison of counting data by 蠂 2 test (P0.05). [results] 1. General situation: 62 cases were included in the study, including 32 cases in NIPPV group and 30 cases in NCPAP group. Sex, gestational age, birth weight, age, postnatal 5min Apgar score, neonatal acute physiology score, perinatal supplement 鈪，

本文編號：1819027