摘要目的 观察鼻塞持续呼吸道正压通气(nCPAP)和双相呼吸道正压通气(BIPAP)治疗轻中度新生儿呼吸窘迫综合征(NRDS)对氧交换指标的影响.方法 对116例轻中度新生儿呼吸衰竭在使用肺表面活性物质后,分别进行nCPAP((75例)和BIPAP(41例)治疗,观察治疗前、治疗2、8和24 h患儿6项氧交换指标动脉血氧分压[pa(O2)]、改良氧合指数(P/F)、肺泡-动脉氧分压差(A-aDO2)、呼吸指数(RI)、动脉/肺泡氧分压比值[pa(O2)/pA(O2)]和肺分流分数(Qs/Qt)的变化.结果 治疗前,nCPAP组和BIPAP组pa(O2) (kPa)(6.1-±0.6比6.1 ±0.6,t =0.11,P ＞0.05)、P/F (kPa)(15.59±1.45比15.71±1.45,t=1.59,P＞ 0.05)、A-aDO2 (kPa) (6.04 ±0.64比6.24 ±0.69,t=1.59,P ＞0.05)、RI(6.0±1.0比6.2±1.1,t=1.35,P ＞0.05)、pa(O2)/pA(O2)(0.24 ±0.02比0.25 ±0.03,t=1.63,P＞0.05)和Qs/Qt(％)(11.9±1.6比11.6±1.6,f=1.10,P＞0.05)比较,差异均无统计学意义.治疗后nCPAP和BIPAP组氧合指标均有改善,但BIPAP组的A-aDO2、RI,pa(O2)/pA(O2)和Qs/Qt较nCPAP组改善明显,2h时A-aDO2 (kPa)(3.83±0.49比4.24 ±0.67,t=18.26,P ＜0.05)、RI(2.7 ±0.5比3.3 ±0.7,t =20.59,P＜0.05)、p,(O2)/pA(O2) (0.35 ±0.03比0.32±0.04,t=15.35,P＜0.05)和Qs/Qt(％)(8.8±1.6比9.8±2.0,=7.68,P＜0.05);24 h时A-aDO2 (kPa)(2.29±1.19比3.07±1.67,t=18.43,P ＜0.05)、RI(1.4±1.4比2.3±1.6,t=25.02,P＜ 0.05)、pa(O2)/pA(O2) (0.49 ±0.10比0.42±0.11,t=14.96,P ＜0.05)和Qs/Qt(％) (6.5 ±3.0比8.5 ±4.4,t=9.59,P＜0.05)差异均有统计学意义,而2组pa(O2)和P/F值在24h差异不明显[pa(O2) (kPa)(12.6±1.0比12.7±1.0,=3.76,P＞0.05),P/F(kPa)(28.49 ±3.17比31.85 ±2.85,t=3.76,P＞0.05)].nCPAP组19例需有创机械通气,而BIPAP组3例需有创机械通气,差异有统计学意义(x2=4.01,P＜0.05);治疗中nCPAP组和BIPAP组的氧交换指标均逐步改善,而需要机械通气的22例均出现氧交换指标恶化或未见改善.BIPAP组呼气末正压(PEEP)为(0.42 ±0.19) kPa,nCPAP组为(0.56±0.23) kPa,2组比较差异有统计学意义(t=3.45,P＜0.01).结论 1.BIPAP和nCPAP均能改善轻中度NRDS的氧交换能力,但BIPAP较nCPAP更加有效,并降低有创通气使用频率和PEEP水平;2.pa(O2)、P/F、pa(O2)/pA(O2)以及RI可能更加合适进行新生儿NRDS氧交换评价.

abstractsObjective To observe the effect of nasal continuous positive airway pressure (nCPAP) and Biphase positive airway pressure (BIPAP) on the oxygen exchange indexes in newborns with mild to moderate neonatal respiratory distress syndrome (NRDS).Methods After infusion of pulmonary suffactant into lung bilaterally,116 cases with mild to moderate NRDS were treated with nCPAP(nCPAP group,n =75) and BIPAP(BIPAP group,n =41) respectively.Oxygen exchange indexes including arterial partial pressure of oxygen [pa (O2)],modified oxygenation index (P/F),alveolar-arterial oxygen tension difference (A-aDO2),respiratory index (RI),artery/alveolar oxygen partial pressure ratio[pa (O2)/pA (O2)] and pulmonary shunt fraction (Qs/Qt) were measured or calculated at 0 (before treatment),2,8 and 24 h after being treated with nCPAP or BIPAP.Results Six different oxygen exchange indexes of Pa (O2),P/F,A-aDO2,RI,pa (O2)/pA(O2) and Qs/Qt in both groups didn't show statistical significance at 0 hour:pa(O2) (kPa) (6.1 ±0.6 vs 6.1 ±0.6,t =0.11,P ＞0.05),P/F(kPa) (15.59 ± 1.45 vs 15.71 ± 1.45,t =1.59,P ＞ 0.05),A-aDO2(kPa)(6.04 ±0.64 vs 6.24 ±0.69,t =1.59,P ＞0.05),RI(6.0 ± 1.0 vs 6.2 ± 1.1,t =1.35,P ＞ 0.05),p,(O2)/pA(O2) (0.24 ±0.02 vs 0.25 ±0.03,t =1.63,P ＞0.05)and Qs/Qt(％)(11.9±1.6 vs 11.6 ± 1.6,t =1.10,P ＞ 0.05).A-aDO2,RI,pa (O2)/pA (O2) and Qs/Qt of BIPAP group had more improvement than those of nCPAP at 2 and 24 h,and oxygen exchange indexes at 2 h of BIPAP group and those of nCPAP group were:A-aDO2 (kPa) (3.83 ±0.49 vs 4.24 ± 0.67,t =18.26,P ＜ 0.05),RI(2.7 ± 0.5 vs 3.3 ±0.7,t =20.59,P ＜ 0.05),p,(O2)/pA(O2) (0.35 ±0.03 vs 0.32 ±0.04,t =15.35,P ＜0.05) and Qs/Qt(％) (8.8 ± 1.6 vs 9.8 ±2.0,t =7.68,P ＜ 0.05) ; 24 h indexes in BIPAP group and the indexes of nCPAP group were:A-aDO2 (kPa) (2.29 ± 1.19 vs 3.07 ± 1.67,t=18.43,P ＜0.05),RI(1.4 ±1.4 vs 2.3 ± 1.6,t=25.02,P ＜0.05),pa(O2)/pA(O2) (0.49 ±0.10 vs 0.42 ±0.11,t =14.96,P ＜0.05) and Qs/Qt(％) (6.5 ±3.0 vs 8.5 ±4.4,t =9.59,P ＜0.05).pa(O2) and P/F of both groups didn't show statistical difference significantly [Pa (O2)(kPa) (12.6 ± 1.0 vs 12.7 ± 1.0,t =3.76,P ＞ 0.05),P/F(28.49 ± 3.17 vs 31.85 ± 2.85,t =3.76.P ＞ 0.05)].Nineteen cases in nCPAP group needed invasive mechanical ventilation,and only 3 cases in BIPAP group underwent the procedure;there was a significant difference (x2 =4.01,P ＜ 0.05).Oxygen exchange indexes in both groups were gradually improved from 2 h,8 h to 24 h,but 22 deteriorated cases showed no improvement,who underwent invasive ventilation.Positive end-expiratory pressure (PEEP) positive airway pressure (EPAP) was (0.42 ± 0.19) kPa in BIPAP group,and (0.56 ± 0.23) kPa in nCPAP group (t =3.45,P ＜ 0.01).Conclusions 1.BIPAP and nCPAP can improve the ability of oxygen exchange in newborns with mild to moderate NRDS,but BIPAP is more effective than nCPAP,which can shorten the possibility of invasive ventilation and reduce the PEEP level.2.p,(O2),P/F,pa (O2)/pA (O2) and RI may be more suitable for evaluating oxygen exchange for neonatal NRDS.