江云

[摘要]目的 探討经鼻间歇指令通气（NIPPV）与经鼻持续正压通气（NCPAP）在早产儿撤机后的应用效果。方法 选取2016年6月～2019年7月我院收治的50例早产儿为研究对象，采用随机数字表法分为对照组（n=25）与观察组（n=25）。对照组采用NCPAP，观察组采取NIPPV。治疗后，比较两组的治疗效果、血气分析指标、患儿恢复情况及近远期并发症发生率。结果 两组拔管7 d内撤机失败情况、动脉二氧化碳分压（PaCO2）、动脉血氧分压（PaO2）、pH、住院总时间、双顶径（BPD）、早产婴儿视网膜病变（ROP）、颅内出血发生率比较，差异无统计学意义（P>0.05）;治疗后，观察组无创通气使用时间、吸入氧浓度（FiO2）低于对照组，差异有统计学意义（P<0.05）。结论 早产儿撤机后，采取NIPPV与NCPAP治疗均能改善患儿缺氧状态，治疗效果显著，但从患儿近远期并发症情况等综合考虑，临床应根据患儿具体情况选择合适通气方案，若患儿条件允许，可优先选择NIPPV，旨在提高患儿生存质量。

[关键词]早产儿;经鼻间歇指令通气;经鼻持续正压通气;并发症

[中图分类号] R722.6          [文献标识码] A          [文章编号] 1674-4721（2020）7（a）-0129-04

Application of nasal intermittent positive pressure ventilation and nasal continuous positive airway pressure after ventilator weaning in preterm infants

JIANG Yun

Department of Neonatology， Jiujiang Maternal and Child Health Hospital， Jiangxi Province， Jiujiang   332000， China

[Abstract] Objective To explore the application effect of nasal intermittent positive pressure ventilation （NIPPV） and nasal continuous positive airway pressure （NCPAP） after ventilator weaning in preterm infants. Methods A total of 50 preterm infants admitted to our hospital from June 2016 to July 2019 were selected as research subjects. They were divided into  control group （n=25） and an observation group （n=25） by random number table method. NCPAP was used in the control group and NIPPV was used in the observation group. After treatment， the treatment effect， indicators of blood gas analysis， recovery， and near-term and long-term complications of the two groups were compared. Results The incidence of ventilator weaning failure within 7 days after extubation， arterial carbon dioxide partial pressure （PaCO2）， arterial partial pressure of oxygen （PaO2）， pH， total hospital stay， biparietal diameter （BPD）， retinopathy of prematurity （ROP）， and the incidence of intracranial hemorrhage of the two groups had no significant differences （P>0.05）. After treatment， the time of non-invasive ventilation and fraction of inspired oxygen （FiO2） in the observation group were lower than those of the control group， and the differences were statistically significant （P<0.05）. Conclusion After ventilator weaning of premature infants， both NIPPV and NCPAP treatment can alleviate the hypoxic state of the infants， and the effect is remarkable. However， taking factors like the short-term and long-term complications of the infants into consideration， ventilation scheme should be appropriately chosen according to the specific conditions of the infants in clinic. If the infants′ condition allows， NIPPV can be preferentially selected to improve their quality of life.

[Key words] Premature infant; Nasal intermittent positive pressure ventilation; Nasal continuous positive airway pressure; Complications

早产患儿常因肺表面缺乏活性物质（PS），导致机体出现进行性呼吸困难，如新生儿呼吸窘迫综合征（neonatal respiratory distress syndrome，RDS）发病后，导致肺泡表面张力降低、肺泡萎缩等，临床表现为呻吟、进行性呼吸困难等，严重者导致死亡，治疗以机械性通气联合PS应用为主。但临床实践表明，机械性通气常导致患儿出现肺部感染、呼吸相关性肺炎等并发症，影响病情恢复[1-2]。减少有创呼吸支持时间和避免再次上机成为临床关注的重点，积极探寻非侵入性治疗对提高患儿生存率，改善治疗效果尤为重要[3]。本研究为探寻经鼻间歇指令通气（nasal intermittent command ventilation，NIPPV）与经鼻持续正压通气（continuous positive pressure ventilation through nose，NCPAP）在早产儿撤机后的应用效果，选取我院收治的50例早产儿，分别在撤机后给予NIPPV与NCPAP通气方式，并分析其应用价值，现报道如下。