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目的探讨间断并延缓撤离鼻塞持续气道正压通气(nCPAP)对极低出生体重的早产儿接受氧疗时间、住院时间、支气管肺发育不良(BPD)发生率的影响。方法选取胎龄27~(+0)~31~(+6)周、出生体重<1 500 g、中-重度呼吸窘迫综合征(RDS)的早产儿92例,随机分为间断并延缓撤离组(n=47)和直接撤离组(n=45),做2年期前瞻性研究。两组均先接受气管插管机械通气联合肺表面活性物质(PS)治疗,撤离呼吸机后接受nCPAP,待病情允许分别实施间断并延缓撤离和直接撤离nCPAP。比较两组撤离nCPAP失败率、再插管率、BPD发生率,以及接受氧疗时间和住院时间。结果间断并延缓撤离组较直接撤离组撤离n CPAP失败率降低(8.5%vs.24.4%;χ~2=4.277,P<0.05),再插管率降低(4.3%vs.17.8%;χ~2=4.339,P<0.05),接受氧疗时间缩短[(19±3)d vs.(21±3)d;t=3.356,P<0.05],住院时间缩短[(42±3)d vs.(44±3)d;t=2.998,P<0.05],差异均有统计学意义;BPD发生率降低(8.5%vs.17.8%;χ~2=1.741,P>0.05),但差异无统计学意义。结论对接受nCPAP治疗的极低出生体重的早产儿采用间断并延缓撤离nCPAP失败率低,能减少再插管机会,能缩短氧疗时间及住院时间。
Objective To investigate the effects of intermittent and delayed nCPAP on the duration of oxygen therapy, length of hospital stay, and incidence of bronchopulmonary dysplasia (BPD) in very low birth weight preterm infants. Methods 92 preterm infants with gestational age of 27 ~ (+0) ~ 31 ~ (+6) weeks, birth weight <1 500 g and moderate to severe respiratory distress syndrome (RDS) were randomly divided into intermittent and delayed evacuation group (n = 47) and direct evacuation group (n = 45) for a 2-year prospective study. Both groups received tracheal intubation mechanical ventilation combined with pulmonary surfactant (PS) treatment. After exiting the ventilator, nCPAP was given to both groups, and the condition was allowed to be interrupted and delayed withdrawal and direct withdrawal from nCPAP respectively. The failure rates of nCPAP withdrawal, reintubation rate, incidence of BPD, and duration of oxygen therapy and hospital stay were compared between the two groups. Results Intermittent and delayed withdrawal group compared with the direct withdrawal group n CPAP failure rate decreased (8.5% vs.24.4%; χ ~ 2 = 4.277, P <0.05), reintubation rate decreased (4.3% vs.17.8% (42 ± 3) days vs 2 weeks (4.339, P <0.05), shorter duration of oxygen therapy (19 ± 3 days vs. 21 ± 3 days, t = 3.356, P < (44 ± 3) d, t = 2.998, P <0.05], the difference was statistically significant; the incidence of BPD was lower (8.5% vs.17.8%; χ ~ 2 = 1.741, P> 0.05) Statistical significance. Conclusions The low failure rate of intermittent and delayed withdrawal of nCPAP in preterm infants with very low birth weight who received nCPAP treatment can reduce the chance of reintubation and shorten the duration of oxygen therapy and hospital stay.