Influence of different breathing patterns on clinical rehabilitation in neonatal respiratory distress syndrome

doi:10.3877/cma.j.issn.1673-5250.2016.02.014

Objective

To observe the influence of nasal continuous positive airway pressure (NCPAP), conventional mechanical ventilation (CMV) and high-frequency oscillatory ventilation (HFOV) combined with pulmonary surfactant (PS) in the treatment of neonatal respiratory distress syndrome (NRDS).

Methods

From January 2011 to May 2015, a total of 151 cases with NRDS who were admitted to Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University were included into this study. They were randomly divided into NCPAP group (n=55), CMV group (n=48) and HFOV group (n=48) according to different breathing patterns. The three groups accepted PS replacement treatment and corresponding conventional treatment. There were no significant differences among three groups in the aspects of gestational age, delivery modes, birth weight, NRDS classfication (P>0.05). The blood gas analysis results, duration of assisted ventilation, hospitalization, duration of oxygen therapy and the incidence of pneumothorax, ventilator associated pneumonia(VAP) and bronchopulmonary dysplasia (BPD) were compared among three groups by statistic methods. The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shenzhen Shajing Affiliated Hospital of Guangzhou Medical University. Informed consent was obtained from each participate's parents.

Results

①There were significant differences of pH value, pertial pressure of oxygen in artery (PaO₂) and partial pressure of carbon dioxide (PaCO₂) at different time points (before the treatment, 2, 12, 24 and 72 h after the treatment) among three groups. ② There were significant differences among three groups in the aspects of duration of assisted ventilation, hospitalization, duration of oxygen therapy and the incidence of pneumothorax, VAP and BPD (P<0.05). The incidence of VAP, BPD, duration of assisted ventilation, hospitalization, duration of oxygen therapy of NCPAP group were lower than those of CMV group and HFOV group, the differences were statistically significant (P<0.05). The incidence of pneumothorax of CMV group was higher than that of NCPAP group and HFOV group, respectively, and both the difference has significant (P<0.05), but there was no significant between NCPAP group and HFOV group (P>0.05).

Conclusions

NCPAP has definite curative effects on the treatment of NRDS, and also could effectively reduce the incidences of complications, shorten the duration of ventilation, hospitalization, duration of oxygen therapy. It is worthy of clinical popularization and application in basic-level hospitals.

Key words: Respiratory distress syndrome, newborn, Continuous positive airway pressure, Conventional mechanical ventilation, High-frequency ventilation

表1 3组NRDS患儿治疗后不同时间点血气分析结果比较(±s)

组别		例数	治疗前	治疗后				F值	P值
组别		例数	治疗前	2 h	12 h	24 h	72 h	F值	P值
NCPAP组		55
	pH值		7.2±0.2	7.3±0.3	7.3±0.1	7.3±0.1	7.4±0.2	7.596	0.000
	PaO₂ (mmHg)		44.7±3.6	52.3±1.9	52.8±2.6	64.9±4.8	72.4±5.1	465.100	0.000
	PaCO₂ (mmHg)		52.7±7.9	50.6±5.6	42.8±4.2	45.0±3.3	42.5±3.5	44.430	0.000
CMV组		48
	pH值		7.2±0.1	7.2±0.1	7.2±0.1	7.3±0.1	7.3±0.2	11.820	0.000
	PaO₂ (mmHg)		43.5±4.0	51.1±1.8	51.9±2.1	62.2±4.4	66.5±4.2	337.500	0.000
	PaCO₂ (mmHg)		60.6±7.5	55.7±5.2	48.9±3.8	48.5±3.7	54.8±3.3	50.480	0.000
HFOV组		48
	pH值		7.2±0.1	7.2±0.2	7.3±0.1	7.3±0.1	7.4±0.1	14.830	0.000
	PaO₂ (mmHg)		45.1±3.2	52.8±1.7	53.0±1.8	64.6±4.6	70.5±4.8	411.200	0.000
	PaCO₂ (mmHg)		57.4±6.8	53.5±4.8	43.6±3.3	44.1±3.0	48.1±3.1	87.600	0.000

表1 3组NRDS患儿治疗后不同时间点血气分析结果比较(±s)

组别		例数	治疗前	治疗后				F值	P值
组别		例数	治疗前	2 h	12 h	24 h	72 h	F值	P值
NCPAP组		55
	pH值		7.2±0.2	7.3±0.3	7.3±0.1	7.3±0.1	7.4±0.2	7.596	0.000
	PaO₂ (mmHg)		44.7±3.6	52.3±1.9	52.8±2.6	64.9±4.8	72.4±5.1	465.100	0.000
	PaCO₂ (mmHg)		52.7±7.9	50.6±5.6	42.8±4.2	45.0±3.3	42.5±3.5	44.430	0.000
CMV组		48
	pH值		7.2±0.1	7.2±0.1	7.2±0.1	7.3±0.1	7.3±0.2	11.820	0.000
	PaO₂ (mmHg)		43.5±4.0	51.1±1.8	51.9±2.1	62.2±4.4	66.5±4.2	337.500	0.000
	PaCO₂ (mmHg)		60.6±7.5	55.7±5.2	48.9±3.8	48.5±3.7	54.8±3.3	50.480	0.000
HFOV组		48
	pH值		7.2±0.1	7.2±0.2	7.3±0.1	7.3±0.1	7.4±0.1	14.830	0.000
	PaO₂ (mmHg)		45.1±3.2	52.8±1.7	53.0±1.8	64.6±4.6	70.5±4.8	411.200	0.000
	PaCO₂ (mmHg)		57.4±6.8	53.5±4.8	43.6±3.3	44.1±3.0	48.1±3.1	87.600	0.000

表2 3组NRDS患儿辅助通气时间、住院时间、氧疗时间及并发症发生率比较(±s)

组别	例数	辅助通气时间(h)	住院时间(d)	氧疗时间(h)	气胸发生率[例数(%)]	VAP发生率[例数(%)]	BPD发生率[例数(%)]
NCPAP组	55	72.2±9.5	17.5±5.1	96.3±10.2	0	3 (5.5)	1 (1.8)
CMV组	48	110.4±12.3	30.8±6.1	122.3±18.9	6(12.5)	12(25.0)	8(16.7)
HFOV组	48	98.6±10.1	29.2±5.8	115.3±11.4	1 (2.1)	9(18.8)	6(12.5)
F值/χ²值		175.600	86.360	48.990	10.096	7.754	6.834
P值		0.000	0.000	0.000	0.006	0.021	0.033

表2 3组NRDS患儿辅助通气时间、住院时间、氧疗时间及并发症发生率比较(±s)

组别	例数	辅助通气时间(h)	住院时间(d)	氧疗时间(h)	气胸发生率[例数(%)]	VAP发生率[例数(%)]	BPD发生率[例数(%)]
NCPAP组	55	72.2±9.5	17.5±5.1	96.3±10.2	0	3 (5.5)	1 (1.8)
CMV组	48	110.4±12.3	30.8±6.1	122.3±18.9	6(12.5)	12(25.0)	8(16.7)
HFOV组	48	98.6±10.1	29.2±5.8	115.3±11.4	1 (2.1)	9(18.8)	6(12.5)
F值/χ²值		175.600	86.360	48.990	10.096	7.754	6.834
P值		0.000	0.000	0.000	0.006	0.021	0.033

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