Miksch Ruth-Maria, Armbrust Sven, Pahnke Jens, Fusch Christoph
Department of Neonatology and Pediatric Intensive Care, University Children's Hospital Greifswald, Soldmannstrasse 15, 17475, Greifswald, Germany.
Eur J Pediatr. 2008 Aug;167(8):909-16. doi: 10.1007/s00431-007-0646-1. Epub 2008 Jan 3.
In this paper, a retrospective study was performed to find out whether the introduction of early nasal continuous positive airway pressure (nCPAP) as a new standard regime of very low birthweight infants will lead to a decreasing tracheal intubation and ventilation rate, as well as to a lower incidence of bronchopulmonary dysplasia in a tertiary-level perinatal centre. Ninety-three infants (study group) with early nCPAP as the first respiratory support were compared to 63 infants (historical control group) born before the use of early nCPAP. No statistically significant differences were found in the baseline characteristics. The main results of the study include reduced intubation mainly in infants with a birthweight <1,000 g (study group): 58% vs. 81% (p < 0.05). The mean duration of ventilation was 248 h (control group) vs. 128 h (study group) (p < 0.001) and 437 h vs. 198 h in infants <1,000 g (p < 0.001). There was significantly reduced incidence of bronchopulmonary dysplasia from 55% to 18% for all surviving infants (p < 0.001), and for infants <1,000 g, it was 90% vs. 30% (p < 0.001). No significant differences for other outcome criteria were noted, but a significant reduction in the use of central i.v. lines, fluids, drugs, volume expansion, sedation, catecholamines, surfactant, steroids and buffer, as well as antibiotics, was observed (p < 0.05). Therefore, we can conclude that early nCPAP is an easy-to-use and safe procedure for very low birthweight infants to treat respiratory distress.
在本文中，我们进行了一项回顾性研究，以探究在一家三级围产期中心，将早期鼻持续气道正压通气（nCPAP）作为极低出生体重儿的新标准治疗方案，是否会降低气管插管和机械通气率，以及降低支气管肺发育不良的发生率。将93例接受早期nCPAP作为首次呼吸支持的婴儿（研究组）与63例在早期nCPAP应用之前出生的婴儿（历史对照组）进行比较。两组的基线特征无统计学显著差异。该研究的主要结果包括，主要是出生体重<1000g的婴儿插管率降低（研究组）：58% 对比 81%（p<0.05）。所有婴儿的平均机械通气时长，对照组为248小时，研究组为128小时（p<0.001）；出生体重<1000g的婴儿，平均机械通气时长分别为437小时和198小时（p<0.001）。所有存活婴儿支气管肺发育不良的发生率显著降低，从55%降至18%（p<0.001）；出生体重<1000g的婴儿，该发生率从90%降至30%（p<0.001）。其他结局指标未发现显著差异，但观察到中心静脉置管、液体、药物、扩容、镇静、儿茶酚胺、表面活性剂、类固醇、缓冲液以及抗生素的使用显著减少（p<0.05）。因此，我们可以得出结论，早期nCPAP对于治疗极低出生体重儿的呼吸窘迫是一种易于使用且安全的方法。
