梁格，王军，王伟

（1.徐州医科大学附属儿童医院，江苏 徐州221000；2. 徐州医科大学附属医院，江苏 徐州221000）

Abstrac: Objective To compare the effects of nasal simultaneous intermittent mandatory ventilation (nSIMV)and nasal intermittent positive pressure ventilation (NIPPV) combined with caffeine on premature infants with severe acute respiratory distress syndrome (ARDS) after weaning. Methods The clinical data of 87 cases of severe ARDS of premature infants admitted to our hospital from March 2018 to March 2019 were treated with mechanical ventilation.Among them, 41 cases were treated with nSIMV combined with caffeine as group A after weaning, and the rest 46 cases were treated with NIPPV combined with caffeine as group B. The success rates of weaning and rescue, respiratory support time, total hospitalization time, blood gas analysis index changes, and complication rates were compared. Results Six cases died in group A (2 died within 72 hours after the first weaning, 4 died 72 hours after the first weaning), and 1 case died in group B (within 72 hours after the first weaning).The success rates of weaning and rescue in group B were higher than those in group A (P ＜0.05). Respiratory support time and total hospitalization time in group B were shorter than those in group A (P ＜0.05). The values of pH and PaO2 in group B were higher than those in group A after 72 hours (P ＜0.05), and the values of carbon dioxide (PaCO2) and concentration of inhaled oxygen (FiO2) after 72 hours were lower than those in group A(P ＜0.05). In group A, The pH after 48 hours and PaO2 after 48 and 72 hours were higher than those at the first time of weaning, which after 72 hours were higher than those after 24 hours, and the PaCO2 after 48 and 72 hours were lower than those at the first time of weaning and after 24 hours, and the FiO2 after 72 hours was lower than those at the first time of weaning and after 24 and 48 hours (P ＜0.05). In group B, the pH and PaO2 after 48 and 72 hours were higher than those at the first time of weaning, and those after 72 hours were higher than those after 48 hours, and the PaCO2 levels after 48 and 72 hours were lower than those at the first time of weaning and after 24 hours, and the PaCO2 level after 72 hours was lower than that after 48 hours, and the FiO2 level after 72 hours was lower than those at the first time of weaning and after 24 and 48 hours (P ＜0.05). The incidence of total complications in group B was lower than that in group A(P ＜0.05).Conclusion NIPPV combined with caffeine is recommended for premature infants with severe ARDS after weaning.Compared with nSIMV combined with caffeine, NIPPV combined with caffeine can improve weaning success rate and cure success rate, accelerate recovery, and improve blood gas analysis indexes, which can help control the risk of complications.

急性呼吸窘迫综合征（acute respiratory distress syndrome, ARDS）是新生儿尤其是早产儿中的常见病，以顽固性低氧血症为显著特征，临床治疗难度大且病死率高，是目前我国严重威胁新生儿生命安全的临床综合征类型之一。据统计，新生儿ARDS的发病率约为0.7%～4.2%，在早产儿中的发病率更高，约为11%[1]。另有报道显示[2]，早产儿ARDS 的病死率约为40%～70%，证明该疾病的危害严重。机械通气是重度ARDS 早产儿常用的治疗方案，可为患儿提供通气支持，维持正常的呼吸状态，但不宜长时间机械通气。而ARDS 撤机后的通气支持方案一直是临床医师关注的重点问题[3-4]。研究认为[5]，鼻塞式同步间歇指令通气（nasal synchronized intermittent mandatory ventilation, nSIMV）在ARDS 新生儿撤机后的应用相较于经鼻持续气道正压通气（nasal-continuous positiveairway pressure, NCPAP） 有优势，而经鼻间歇正压通气（nasal intermittent positive pres-sure ventilation, NIPPV）是NCPAP 的 一种增强模式，包含了同步间歇指令通气和NCPAP[6]。但关于nSIMV 与NCPAP 在重度ARDS 早产儿撤机后的应用对比报道尚少。咖啡因属于甲基黄嘌呤类药物，可兴奋呼吸中枢，解除呼吸抑制，是早产儿ARDS 常用的药物[7]。鉴于此，本研究回顾性分析nSIMV 或NIPPV 联合咖啡因治疗重度ARDS 早产儿撤机后的作用，现报道如下。

1 资料与方法

1.1 临床资料

选取2018年3月—2019年3月徐州医科大学附属儿童医院收治的87例重度ARDS早产儿临床资料。均实施机械通气，其中，41 例撤机后接受nSIMV 联合咖啡因治疗（A组），46例撤机后接受NIPPV 联合咖啡因治疗（B 组）。A 组男婴24 例，女婴17 例；出生日龄2 h 至12 d，平均（4.12±1.05）d；出生体重1 120～2 450 g，平均（1 896.71±144.83）g；出生孕周28～36 周，平均（31.32±2.07）周；X 射线片示双肺透亮度低、呈毛玻璃状，肺部可见小点片状或斑片状阴影32 例，可见支气管充气征29 例，呈白肺改变20 例；……