早期持续气道正压通气对极早产儿肺功能的积极影响：COIN 试验亚组分析结果。
Positive effects of early continuous positive airway pressure on pulmonary function in extremely premature infants: results of a subgroup analysis of the COIN trial.
机构信息
Clinic for Neonatology, Charité Universitätsmedizin Berlin, Berlin, Germany.
出版信息
Arch Dis Child Fetal Neonatal Ed. 2011 Sep;96(5):F371-3. doi: 10.1136/adc.2009.181008. Epub 2010 Jun 28.
OBJECTIVE
Early continuous positive airway pressure (CPAP) may reduce lung injury in preterm infants.
PATIENTS AND METHODS
Spontaneously breathing preterm infants were randomised immediately after birth to nasal CPAP or intubation, surfactant treatment and mechanical ventilation. Pulmonary function tests approximately 8 weeks post-term determined tidal breathing parameters, respiratory mechanics and functional residual capacity (FRC).
RESULTS
Seventeen infants received CPAP and 22 mechanical ventilation. Infants with early CPAP had less mechanical ventilation (4 vs 7.5 days; p=0.004) and less total respiratory support (30 vs 47 days; p=0.017). Post-term the CPAP group had lower respiratory rate (41 vs 48/min; p=0.007), lower minute ventilation (223 vs 265 ml/min/kg; p=0.009), better respiratory compliance (0.99 vs 0.82 ml/cm H(2)O/kg; p=0.008) and improved elastic work of breathing (p=0.004). No differences in FRC were found.
CONCLUSIONS
Early CPAP is feasible, shortens the duration of respiratory support and results in improved lung mechanics and decreased work of breathing.
目的
早期持续气道正压通气（CPAP）可能减轻早产儿肺损伤。
患者与方法
自主呼吸的早产儿出生后立即随机接受鼻 CPAP 或插管、表面活性剂治疗和机械通气。接近足月后进行肺功能测试，确定潮气呼吸参数、呼吸力学和功能残气量（FRC）。
结果
17 例婴儿接受 CPAP，22 例接受机械通气。早期 CPAP 组机械通气时间更短（4 天 vs 7.5 天；p=0.004），总呼吸支持时间更短（30 天 vs 47 天；p=0.017）。接近足月时，CPAP 组呼吸频率更低（41 次/min vs 48 次/min；p=0.007），分钟通气量更低（223ml/min/kg vs 265ml/min/kg；p=0.009），呼吸顺应性更好（0.99ml/cm H₂O/kg vs 0.82ml/cm H₂O/kg；p=0.008），呼吸弹性功改善（p=0.004）。FRC 无差异。
结论
早期 CPAP 是可行的，可缩短呼吸支持时间，改善肺力学，降低呼吸功。
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