Heiring Christian, Steensberg Jesper, Bjerager Mia, Greisen Gorm
Department of Neonatology, Rigshospitalet, Copenhagen, Denmark.
Neonatology. 2015;108(4):259-65. doi: 10.1159/000437203. Epub 2015 Aug 28.
Nasal continuous positive airway pressure (nCPAP) stabilizes the residual volume and may decrease the risk of 'atelectotrauma', potentially promoting lung development in neonates.
To assess whether replacing nCPAP by low-flow O2 by nasal cannula affects lung function expressed as the arterial/alveolar oxygen tension ratio (a/A pO2 ratio) on postnatal day 28.
Preterm infants (birth weight <1,500 g and gestational age, GA >26 + 0 weeks) stable on nCPAP between postnatal days 4 and 7 were randomized to nCPAP or low-flow O2 by nasal cannula (<0.2 liters/min). Study criteria defined how to wean/restart respiratory support or change from low-flow O2 to nCPAP and vice versa. Transcutaneous monitoring was used for the assessment of the a/A pO2 ratio on day 28 using a head box for all infants for accurate measurement and to eliminate possible effects from nCPAP or low-flow O2 on oxygen requirement.
We enrolled 52 infants (nCPAP group n = 30 and low-flow O2 group n = 22). The a/A pO2 ratio at 28 days was 0.43 ± 0.17 (nCPAP group) versus 0.48 ± 0.18 (p = 0.36). The duration of nCPAP was 16.4 (low-flow group) versus 41.1 days (nCPAP group), p < 0.001. There was no difference between groups in the fraction needing any respiratory support at 36 weeks' corrected age, length of stay, weight at discharge, and relative weight gain.
Replacing nCPAP by low-flow O2 in preterm infants with GA >26 weeks at the end of the first week of life did not seem to affect the a/A pO2 ratio or weight gain negatively. Thus, prolonged nCPAP seems not to have a positive effect on lung function at 28 days of life and replacement by low-flow O2 could reduce the cost of equipment and increase the ease of nursing.
经鼻持续气道正压通气（nCPAP）可稳定残气量，并可能降低“肺不张性创伤”的风险，从而有可能促进新生儿的肺发育。
评估在出生后第28天，用鼻导管低流量吸氧替代nCPAP是否会影响以动脉/肺泡氧分压比（a/A pO2比）表示的肺功能。
出生体重<1500克且胎龄（GA）>26 + 0周、在出生后第4至7天使用nCPAP稳定的早产儿被随机分为nCPAP组或鼻导管低流量吸氧组（<0.2升/分钟）。研究标准定义了如何撤机/重启呼吸支持，或从低流量吸氧改为nCPAP，反之亦然。在出生后第28天，对所有婴儿使用头箱进行经皮监测以评估a/A pO2比，以进行准确测量并消除nCPAP或低流量吸氧对氧需求的可能影响。
我们纳入了52名婴儿（nCPAP组n = 30，低流量吸氧组n = 22）。出生后第28天的a/A pO2比，nCPAP组为0.43±0.17，低流量吸氧组为0.48±0.18（p = 0.36）。nCPAP的使用时长，低流量吸氧组为16.4天，nCPAP组为41.1天，p < 0.001。在矫正年龄36周时需要任何呼吸支持的比例、住院时长、出院体重和相对体重增加方面，两组之间没有差异。
在出生后第一周结束时，对于GA>26周的早产儿，用低流量吸氧替代nCPAP似乎不会对a/A pO2比或体重增加产生负面影响。因此，延长nCPAP使用时间似乎对出生后第28天的肺功能没有积极影响，用低流量吸氧替代可降低设备成本并增加护理便利性。
