Jeena Prakash, Pillay Paramesha, Adhikari Miriam
Department of Paediatrics and Child Health, Nelson R Mandela School of Medicine, University of Natal, King Edward VIII Hospital, Durban, South Africa.
Ann Trop Paediatr. 2002 Sep;22(3):201-7. doi: 10.1179/027249302125001480.
Outcome in neonates with acute respiratory failure supported initially either by rescue mechanical ventilation (IPPV) or by nasal continuous positive airway pressure (NCPAP) was compared in a retrospective review of cases seen at King Edward VIII Hospital between January and December 2000. IPPV and NCPAP were required by 89 and 85 neonates, respectively. The median weights (1900 vs 1650 g), male to female ratios (1.74:1 vs 1.34:1) and median gestational ages (32 vs 34 weeks) were similar in the two groups. Of the 89 neonates who required IPPV, 17 failed initial NCPAP and seven required ventilatory support for secondary reasons after NCPAP was initially successful. In the remainder (n = 65) who initially received IPPV, the mortality rate was 39% (n = 25) compared with 25% (n = 21) in the group who received NCPAP initially. Sixty-three neonates (74%) were initially successfully supported with NCPAP alone. Of these, fifty (79%) required no further respiratory support until discharge and seven received IPPV subsequently, five of whom died; six who were not offered mechanical ventilation also died. NCPAP did not provide adequate respiratory support in 22 newborns (26%). Of these, 17 received IPPV, five of whom died, and five who were not offered mechanical ventilation also died. Hyaline membrane disease and congenital pneumonia were the common primary diagnoses in both groups. NCPAP was a useful adjunct to mechanical ventilation in treating newborns for a variety of disorders causing respiratory failure. The delay in instituting mechanical ventilation by initial use of NCPAP did not adversely affect outcome.
在对2000年1月至12月在爱德华八世国王医院就诊病例的回顾性研究中，比较了最初通过抢救性机械通气（IPPV）或经鼻持续气道正压通气（NCPAP）支持的急性呼吸衰竭新生儿的结局。分别有89例和85例新生儿需要IPPV和NCPAP。两组的中位体重（1900 vs 1650 g）、男女比例（1.74:1 vs 1.34:1）和中位胎龄（32 vs 34周）相似。在89例需要IPPV的新生儿中，17例最初NCPAP失败，7例在NCPAP最初成功后因继发原因需要通气支持。在其余最初接受IPPV的65例（n = 65）中，死亡率为39%（n = 25），而最初接受NCPAP的组死亡率为25%（n = 21）。63例（74%）新生儿最初仅通过NCPAP成功得到支持。其中，50例（79%）直至出院都无需进一步呼吸支持，7例随后接受了IPPV，其中5例死亡；6例未接受机械通气的也死亡。22例（26%）新生儿中NCPAP未能提供足够的呼吸支持。其中，17例接受了IPPV，5例死亡，5例未接受机械通气的也死亡。透明膜病和先天性肺炎是两组常见的主要诊断。NCPAP是机械通气治疗导致呼吸衰竭的各种新生儿疾病的有用辅助手段。最初使用NCPAP延迟启动机械通气并未对结局产生不利影响。
