Al-balkhi A, Klonin H, Marinaki K, Southall D P, Thomas D A, Jones P, Samuels M P
Department of Paediatrics, University Hospital, Queen's Medical Centre, Nottingham, UK.
Arch Dis Child. 2005 Mar;90(3):288-91. doi: 10.1136/adc.2003.039404.
To determine whether the use of negative pressure ventilation (NPV) was associated with a lower rate of endotracheal intubation in infants with recurrent apnoea secondary to acute bronchiolitis.
Retrospective review of two paediatric intensive care units (PICU) databases and case notes; one PICU offered NPV.
Fifty two infants with bronchiolitis related apnoea were admitted to the two PICUs (31 to the NPV centre). There were no significant differences between infants in the two centres in age and weight on admission, gestational age at birth, birth weight, history of apnoea of prematurity or chronic lung disease, days ill before referral, respiratory syncytial virus status, oxygen requirement before support, and numbers retrieved from secondary care centres. Respiratory support was provided to all 31 infants in the NPV centre (23 NPV, 8 PPV), and 19/21 in the non-NPV centre (18 PPV, 1 CPAP); the NPV centre had lower rates of endotracheal intubation rates (8/31 v 18/21), shorter durations of stay (median 2 v 7 days), and less use of sedation (16/31 v 18/21). In the two years after the NPV centre discontinued use of NPV, 14/17 (82%) referred cases were intubated, with a median PICU stay of 7.5 days.
The use of NPV was associated with a reduced rate of endotracheal intubation, and shorter PICU stay. A prospective randomised controlled trial of the use of NPV in the treatment of bronchiolitis related apnoea is warranted.
确定在因急性细支气管炎继发反复呼吸暂停的婴儿中，使用负压通气（NPV）是否与较低的气管插管率相关。
回顾性分析两个儿科重症监护病房（PICU）的数据库和病例记录；其中一个PICU提供NPV。
52例与细支气管炎相关呼吸暂停的婴儿被收治到这两个PICU（31例至NPV中心）。两个中心的婴儿在入院时的年龄和体重、出生时的胎龄、出生体重、早产呼吸暂停或慢性肺病病史、转诊前患病天数、呼吸道合胞病毒状态、支持前的氧需求以及从二级护理中心转入的人数方面均无显著差异。NPV中心的所有31例婴儿均接受了呼吸支持（23例使用NPV，8例使用正压通气[PPV]），非NPV中心的21例中有19例接受了呼吸支持（18例使用PPV，1例使用持续气道正压通气[CPAP]）；NPV中心的气管插管率较低（8/31对比18/21）、住院时间较短（中位数2天对比7天）且镇静剂使用较少（16/31对比18/21）。在NPV中心停止使用NPV后的两年里，17例转诊病例中有14例（82%）进行了插管，PICU住院时间中位数为7.5天。
使用NPV与降低气管插管率及缩短PICU住院时间相关。有必要对NPV用于治疗细支气管炎相关呼吸暂停进行前瞻性随机对照试验。
