双水平正压通气在表面活性物质治疗早产儿中的应用

Role of bilevel positive airway pressure in the management of preterm newborns who have received surfactant.

机构信息

Department of Woman, Child and Adolescent Health, Sant'Orsola Hospital, University of Bologna, Bologna, Italy.

出版信息

Acta Paediatr. 2010 Dec;99(12):1807-11. doi: 10.1111/j.1651-2227.2010.01910.x.

DOI:10.1111/j.1651-2227.2010.01910.x

PMID:20545934

Abstract

AIM

Surfactant given during brief intubation followed by immediate extubation on nasal continuous positive airway pressure [Intubation-Surfactant-Extubation (InSurE) approach] is used to treat respiratory distress syndrome in newborns. Our aim was to evaluate whether bilevel positive airway pressure (BiPAP) after InSurE failure is able to prevent the need for mechanical ventilation (MV).

METHODS

Chart data of infants with a birth weight <1500 gr or GA <32weeks undergoing InSurE in the period 2002-2008 in an Italian Tertiary Neonatal Intensive Care Unit were reviewed retrospectively. InSurE failure was defined as follows: FiO(2) >0.4, respiratory acidosis or intractable apnoea within 1 week. After InSurE failure, newborns born before the implementation of BiPAP (historical control group) received MV, whereas those born after BiPAP implementation (BiPAP group) received BiPAP and underwent MV only if failure criteria persisted. The two groups were compared to evaluate whether BiPAP reduced the need for MV in the 7 days after InSurE failure.

RESULTS

Six of twenty-two (27%) and 14 of the 38 (37%) infants failed InSurE in the two groups, respectively (p > 0.05). Need for MV was 27% in the historical control group versus 0% in the BiPAP group (risk estimate, 3.38; 95% CI, 2.24, 5.09; p = 0.001).

CONCLUSIONS

BiPAP reduced the need for MV after InSurE failure.

摘要

目的

在经鼻持续气道正压通气（NCPAP）下进行短暂插管后给予表面活性剂（Intubation-Surfactant-Extubation [InSurE] 方法），用于治疗新生儿呼吸窘迫综合征。我们的目的是评估 InSurE 失败后使用双相气道正压通气（BiPAP）是否能够预防需要机械通气（MV）。

方法

回顾性分析 2002 年至 2008 年期间在意大利三级新生儿重症监护病房接受 InSurE 治疗、出生体重 <1500g 或胎龄 <32 周的婴儿的图表数据。InSurE 失败定义为：FiO(2) >0.4、呼吸性酸中毒或 1 周内难以控制的呼吸暂停。InSurE 失败后，在 BiPAP 实施前出生的新生儿（历史对照组）接受 MV，而在 BiPAP 实施后出生的新生儿（BiPAP 组）接受 BiPAP，如果失败标准持续存在则接受 MV。比较两组以评估 BiPAP 是否降低 InSurE 失败后 7 天内 MV 的需求。