nSIMV 或NIPPV 联合咖啡因在重度ARDS早产儿撤机后的应用研究

Application of nSIMV or NIPPV combined with caffeine in premature infants with severe ARDS after weaning

摘要:

目的 比较鼻塞式同步间歇指令通气（nSIMV）或经鼻间歇正压通气（NIPPV）联合咖啡因在重度 急性呼吸窘迫综合征（ARDS）早产儿撤机后的应用效果。方法 选取2018年3月—2019年3月徐州医科大学附 属儿童医院收治的重度ARDS早产儿87例临床资料，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）。比较两组撤机成功率、救治成功率、救治成功 患儿呼吸支持时间、总住院时间，血气分析指标变化及并发症发生率。结果 A组有6例患儿死亡（2例死于首次 撤机后72 h内、4例死于首次撤机后72 h后），B组有1例患儿死亡（死于首次撤机后72 h内），B组撤机成功率和 救治成功率均高于A组（P <0.05）；B组救治成功患儿呼吸支持时间、总住院时间均短于A组（P <0.05）；B组72 h后pH值、PaO2均高于A组（P <0.05），B组72 h后PaCO2、FiO2均低于A组（P <0.05），A组72 h后pH值、48 h后、72 h后PaO2均高于首次撤机时，72 h后均高于24 h，48 h、72 h后PaCO2均低于首次撤机时、24 h，72 h后 FiO2均低于首次撤机时、24 h、48 h后（P <0.05），B组48 h、72 h后pH值、PaO2均高于首次撤机时，72 h后均高 于48 h，48 h、72 h后PaCO2均低于首次撤机时、24 h后，且72 h后PaCO2低于48 h，72 h后FiO2均低于首次撤机 时、24 h、48 h后（P <0.05）；B组总并发症发生率低于A组（P <0.05）。结论 在重度ARDS早产儿撤机后建议 采用NIPPV联合咖啡因治疗，相较于nSIMV联合咖啡因治疗可提高撤机成功率和救治成功率，加快恢复，且还 可改善血气分析指标，有助于控制并发症发生风险。

Abstract:

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, re‐spiratory 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.