Comparison Of Nasal Intermittent Positive Pressure Ventilation And Mechanical Ventilation For Curative Effect Of Neonatal Respiratory Distress Syndrome

Objective：Neonatal respiratory distress syndrome （NRDS），which iscommon in the premature infants, is due to the immature of alveolar â…¡typecell, or hypoxia， acidosis, low temperature suppress the synthesis ofpulmonary surfactant（PS）.The children develop progressive dyspnea，expiratory groaning，purple and respiratory failure after born several hours.Chest X-ray examination can diagnose it, which of typical performance isground-glass opacity and bronchogram. The mortality rate of NRDS is high,and the children can be left serious lung and nervous system sequelae. It isremarkable effect for tracheal intubation mechanical ventilation to cureNRDS, but which can cause many complications， such asventilator-associated pneumonia（VAP）,frequent hemorrhoid，pulmonaryhemorrhage，and so on. To improve the life quality of survivors and reducecomplications, the neonatal intensive care unit（NICU）get attention to thenasal continuous positive airway pressure （NCPAP） for NRDS treatment in1971, whose effect is notable. Whereas, many NRDS children still needtracheal intubation mechanical ventilation treatment after use NCPAP in largenumber of clinical studies[1].In recent years, foreigners pay high attention to the nasal intermittentpositive pressure ventilation（NIPPV）for NRDS treatment.In92NICU ofBritain,72%of which use NIPPV as synchronized device,80%asrescue treatment after failure of NCPAP,59%as routine therapy afterextubation, and10%as the initial treatment[2]. Comparing with NCPAP,someresearches abroad show that NIPPV can significantly reduce proportion ofre-intubation of premature after extubation, which can be seen as NCPAP’senhancement[3]. NIPPV has gradually been tried as initial therapy for respiratory support. Research has shown[4]NRDS children who use NIPPVhas a better effect than NCPAP after both injected in PS. However, it is fewercontrast for NIPPV with tracheal intubation mechanical ventilation. Thisarticle through the clinical data to observe curative effect of NIPPV andtracheal intubation mechanical ventilation （SIPPV+VG） for NRDS andNIPPV whether can reduce VAP， pulmonary hemorrhage， frequenthemorrhoid，intracranial hemorrhage.Methods:1The research object:According to diagnostic criteria of NRDS[5]and respiratory failure[6],44cases （30weeks≤gestational age≤34weeks，1000g≤birth weight≤2000g，admission age≤6hours）of children’s hospital in Hebei province who werediagnosed3or4level of NRDS，I type respiratory failure had been randomlydivided into tracheal intubation mechanical ventilation （SIPPV+VG） groupand NIPPV group from January to December in2011, and all children wouldbe injected in PS. There were no difference from both groups for conventionalsupport treatment （maintain normal blood pressure, blood oxygen, acid andalkali balance and nutrition support, etc.）. Compare the two methods of mainindexes, ventilator index，complications，cure and mortality rate.2Groups:SIPPV+VG group: a total of23cases, the male for14cases, andfemale for9cases. Gestational age （32.78±1.65）weeks; birth weight（1684.35±291.14） g; age of admission （3.35±1.72） hours; vagina delivery（premature birth with no obvious cause）for14cases, selective cesarean sectiondelivery for9cases; level3of NRDS for10cases, and level4for13cases.NIPPV group: a total of21cases, the male for12cases, and female for9cases. Gestational age （31.81±2.16）weeks; birth weight （1517.38±285.55） g;age of admission （3.21±1.87） hours; vagina delivery （premature birth with noobvious inducement） for11cases, selective cesarean section delivery for10cases; level3of NRDS for11cases, and level4for10cases.3The experiment steps: The children in NIPPV group and SIPPV+VG group receive standardtreatment, including the appropriate rehydration, antibiotics, nutrition supportwithin the trachea, PS and other drug therapy. Observe children of both groupslife signs and arterial blood gas analysis results and related breathing machineparameters at0h,12h,24h,48h,72h, including PO₂, PCO₂, SaO₂, FiO₂,PaO₂/FiO₂（P/F） and a/APO₂（a/APO₂=PaO₂/[713×FiO₂－PaCO₂/0.8],PaO₂, PaCO₂unit for mmHg,1mmHg=0.133kPa）.Record VAP, frequenthemorrhoid, pulmonary hemorrhage and intracranial hemorrhage, hospitaldays, expense, cure and mortality rate of the two groups in hospital.4Statistical methods：The statistical analysis SPSS13.0statistics software was used to carry onthe statistics processing，at the same time，P<0.05（double side）had statisticalsignificance.Results:1There were23cases in the SIPPV+VG group，and21cases in the NIPPVgroup. Both groups were no statistically significant difference in gestationalage, birth weight, gender, age, delivery mode, the time injected PS and0hrelated index （PaO₂, PaCO₂, P/F, etc）, hospital days, cure and mortality rate （P>0.05）;2Through the chi-square test showed that VAP and frequent hemorrhoid inNIPPV group were lower than SIPPV+VG group,and there were statisticallysignificant differences（P=0.048，P=0.022，P＜0.05）；but pulmonaryhemorrhage and intracranial hemorrhage of the two groups were notstatistically significant differences （P=1.000, P=1.000, P>0.05）;3The ventilation time and cost of the NIPPV group in hospital were lowerthan that of the SIPPV+VG group （P=0.021, P=0.022, P <0.05）, whichwere statistically significant differences;but hospital days was not statisticallysignificant differences;4Oxygen exposure time was significantly shorter in NIPPV group thananother group,（P=0.002, P <0.05）, there was statistically significantdifferences between the two groups; 5The two treatment also had improved PaO₂，FiO₂，SaO₂，P/F and a/APO₂significantly at the time point of12h,24h,48h,72h（P <0.05）, it wasstatistically significant for the seprated group. But the difference between twogroups was not statistically significant.PaCO₂at each point was notstatistically significant whether within and betteen groups.Conclusion:1Tracheal intubation mechanical ventilation and NIPPV both couldsignificantly improve PaO₂,FiO₂, SaO₂,P/F and a/APO₂indexes, which areboth effective for treating respiratory distress syndrome children;2Compared with endotracheal intubation mechanical ventilation,NIPPVcould significantly reduce VAP and frequent hemorrhoid, the specificmechanisms of which still need to discuss;3NIPPV dropped oxygen exposure time，and reduced the ventilation timeand cost, then reduced the burden of families. It is a initial treatment forclinicians treating premature RDS;4If the children’s gestational age <30weeks, autonomous breathing faint,or with type II respiratory failure at admission or during the hospitalization,the first choice should be tracheal intubation mechanical ventilation.