一项前瞻性随机对照试验，比较同步鼻间歇正压通气与鼻持续气道正压通气作为拔管模式的效果。
A prospective randomized, controlled trial comparing synchronized nasal intermittent positive pressure ventilation versus nasal continuous positive airway pressure as modes of extubation.
作者信息
Khalaf M N, Brodsky N, Hurley J, Bhandari V
机构信息
Department of Pediatrics, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
出版信息
Pediatrics. 2001 Jul;108(1):13-7. doi: 10.1542/peds.108.1.13.
OBJECTIVE
To determine whether synchronized nasal intermittent positive pressure ventilation (SNIPPV) would decrease extubation failure compared with nasal continuous positive airway pressure (NCPAP) in preterm infants being ventilated for respiratory distress syndrome (RDS).
METHODS
Infants who were </=34 weeks' gestational age and who were ventilated for RDS were randomized to either SNIPPV or NCPAP after extubation. The criteria for extubation were peak inspiratory pressure of </=16 cm H(2)O, positive end expiratory pressure of </=5 cm H(2)O, intermittent mandatory ventilation rate of 15 to 25, and fraction of inspired oxygen </=0.35. Pulmonary function tests (PFT) were obtained before extubation. After extubation, blood gases were monitored for a minimum of 72 hours. Success was defined as remaining in the selected mode of treatment or demonstrating improvement (switching to oxyhood/nasal cannula/room air) by 72 hours.
RESULTS
Thirty-two (94%) of 34 infants were extubated successfully with the use of SNIPPV versus 18 (60%) of 30 with the use of NCPAP (P <.01). There was no difference in apnea/bradycardia episodes in the 2 groups during the 72-hour study period. Among 55 infants who had PFT, 80% (8 of 10) with dynamic lung compliance of >/=0.5 mL/kg/cm H(2)O and expiratory airway resistance of </=70 cm H(2)O/L/s were extubated successfully. In infants with poor lung function (dynamic lung compliance: <0.5 mL/kg/cm H(2)O; expiratory airway resistance: >70 cm H(2)O/L/s), successful extubation was seen in 93% (27 of 29) in the SNIPPV group and 60% (15 of 25) in the NCPAP group. When weight was controlled for at the time of extubation, the odds of success in the SNIPPV group were 21.1 times higher (95% confidence interval: 3.4, 130.1) than that of the NCPAP group.
CONCLUSIONS
SNIPPV is more effective than NCPAP in weaning infants with RDS from the ventilator. PFT may be useful in predicting successful extubation.
目的
确定在因呼吸窘迫综合征（RDS）接受通气治疗的早产儿中，与经鼻持续气道正压通气（NCPAP）相比，同步经鼻间歇正压通气（SNIPPV）是否会降低拔管失败率。
方法
胎龄≤34周且因RDS接受通气治疗的婴儿在拔管后被随机分为SNIPPV组或NCPAP组。拔管标准为吸气峰压≤16 cm H₂O、呼气末正压≤5 cm H₂O、间歇强制通气频率为15至25次，以及吸入氧分数≤0.35。在拔管前进行肺功能测试（PFT）。拔管后，监测血气至少72小时。成功定义为在72小时内维持在所选治疗模式或显示病情改善（切换至氧帐/鼻导管/室内空气）。
结果
34例婴儿中，32例（94%）使用SNIPPV成功拔管，而30例中18例（60%）使用NCPAP成功拔管（P<.01）。在72小时的研究期间，两组的呼吸暂停/心动过缓发作无差异。在55例进行PFT的婴儿中，动态肺顺应性≥0.5 mL/kg/cm H₂O且呼气气道阻力≤70 cm H₂O/L/s的婴儿中有80%（10例中的8例）成功拔管。在肺功能较差的婴儿（动态肺顺应性：<0.5 mL/kg/cm H₂O；呼气气道阻力：>70 cm H₂O/L/s）中，SNIPPV组93%（29例中的27例）成功拔管，NCPAP组60%（25例中的15例）成功拔管。当在拔管时对体重进行控制后，SNIPPV组成功的几率比NCPAP组高21.1倍（95%置信区间：3.4，130.1）。
结论
在使患有RDS的婴儿撤离呼吸机方面，SNIPPV比NCPAP更有效。PFT可能有助于预测拔管成功。
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