早产儿产房内持续气道正压通气支持不同连接装置治疗效果比较

Comparison of therapeutic effects of continuous positive airway pressure with different connection devices for premature infants in delivery room

摘要

目的 比较极早产儿产房内复苏时使用双鼻孔鼻导管或面罩连接持续气道正压通气的治疗效果。 方法 选择2021年6月至2023年1月在重庆市妇幼保健院出生的极早产儿共249例，依据出生后持续气道正压通气不同连接方式分为双鼻导管组（124例）和面罩组（125例），比较2组的复苏效果、住院情况及并发症发生情况。 结果 在复苏时经双鼻导管连接持续气道正压通气提供持续气道正压的早产儿，生后1 h内血气分析pH值高于面罩组（P<0.05）、PaCO₂值低于面罩组（P<0.05），进入新生儿重症监护病房时的吸氧浓度低于面罩组（P<0.05），2组早产儿心率>100次/min的时间、经皮氧饱和度（SpO₂）>80%的时间、复苏时气管插管率以及生后5 min的Apgar评分差异无统计学意义，2组早产儿Ⅲ~Ⅳ度早产儿脑室周围-脑室内出血发生率、Ⅱ期以上坏死性小肠结肠炎发生率、支气管肺发育不良发生率、早产儿视网膜病发生率差异无统计学意义。 结论 产房内使用双鼻孔鼻导管连接持续气道正压通气提供持续气道正压在改善二氧化碳潴留、减轻酸中毒等方面优于面罩，且不增加早产儿严重并发症的发生，可用于极早产儿产房内稳定。

Abstract

Objective To compare the therapeutic effects of continuous positive airway pressure（CPAP） connected with a dual nasal cannula or a mask during delivery room resuscitation for very premature infants. Methods We included 249 very premature infants born in the Chong Qing Health Center for Women and Children from June 2021 to January 2023，including 124 infants treated with CPAP with a dual nasal cannula and 125 infants treated with CPAP with a mask. The resuscitation effect，hospitalization status，and complications of the two groups were compared. Results Compared with the mask group，the premature infants who received CPAP through a dual nasal cannula during resuscitation had a significantly higher blood pH value within 1 hour after birth（P<0.05），a significantly lower blood PaCO₂ value（P<0.05），and a significantly lower fraction of inspired oxygen when entering the neonatal intensive care unit（P<0.05）. There were no significant differences between the two groups in terms of the duration of heart rate >100 beats per minute，the duration of saturation of peripheral oxygen（SpO₂） >80%，the tracheal intubation rate during resuscitation，and the Apgar score at 5 minutes after birth. The two groups showed no significant differences in the incidence rates of periventricular-intraventricular hemorrhage of grade Ⅲ-Ⅳ，necrotizing enterocolitis of stage Ⅱ or higher，bronchopulmonary dysplasia，and retinopathy of prematurity. Conclusion The use of dual nasal cannulas to connect CPAP in the delivery room is superior to masks in reducing carbon dioxide retention and acidosis，without increasing the occurrence of serious complications in preterm infants，which can be used to stabilize the conditions of very preterm infants in the delivery room.

关键词

早产儿 / 产房内复苏 / 持续气道正压通气

Key words

preterm infant / delivery room resuscitation / continuous positive airway pressure

基金资助

重庆市自然科学基金资助项目(cstc2020jcyj-msxmX0480)

重庆市卫生健康委医学科研资助项目(2024WSJK002)