Evaluation Of Different Duration Of Prone Ventilation In Preterm Infants With Non-invasive Mechanical Ventilation

ObjectiveBy using prone ventilation for different durations for preterm infants with non-invasive mechanical ventilation,it was determined whether prone ventilation for different durations had positive significance for the respiratory function and comfort of preterm infants,thus providing a scientific basis for the position management of preterm infants during non-invasive mechanical ventilation.MethodsThis study is an experimental study.Using convenient sampling and according to the inclusion and exclusion criteria,89 premature infants hospitalized in the neonatology department of a large grade hospital in Xi’an from December 2020 to December 2021 were selected as the research objects.According to the random number table method,they were randomly divided into three groups:control group 30 cases,intervention group A 30 cases,intervention group B 29 cases.On the same basis of treatment and routine nursing,the control group received supine ventilation;The duration of each prone position ventilation in intervention group A was 1h,4 times a day.The duration of prone ventilation in intervention group B was 2h,4 times a day.Compare three groups of premature noninvasive mechanical ventilation time,oxygen cure time,length of hospital stay,the success rate of ventilator,mechanical ventilation related complications（ventilator associated pneumonia,bronchial pulmonary hypoplasia,pneumothorax,intracranial hemorrhage）incidence,adverse reactions（stomach contents reflux/aspiration,damaged skin pressure,all kinds of catheter accidental slip,cornea injury,hemodynamics）occurs Conditions,differences in arterial blood gas indexes(arterial partial oxygen pressure（Pa O₂）,arterial partial carbon dioxide pressure（Pa CO₂）,respiratory index（P（A-a）DO₂/Pa O₂）and oxygenation index（Pa O₂/Fi O₂）,vital signs（heart rate,respiratory rate,blood oxygen saturation）and comfort level.All data were analyzed by SPSS26.0 statistical software,using descriptive statistics,one-way ANOVA,chi-square test,nonparametric test,repeated measures ANOVA,and other statistical methods.Results1.Comparison of premature noninvasive mechanical ventilation time,oxygen cure time,length of stay:between control group and intervention group A,the intervention group B compared to premature noninvasive mechanical ventilation time,oxygen cure time,length of stay the difference was statistically significant（P<0.017）,the difference between the intervention group A and group B intervention has no statistical significance（P>0.017）.2.Comparison of the success rate of premature infants deactivation:The control group was compared with the intervention group B,the difference in the success rate of premature infants weaning was statistically significant（P<0.017）.The comparison between the control group and the intervention group A,the intervention group A and the intervention group B,the difference was not statistically significant（P>0.017）.3.Comparison of mechanical ventilation-related complications and adverse reactions of prone position ventilation in premature infants:There were statistically significant differences in the incidence of premature bronchopulmonary dysplasia between the control group and the intervention group B（P<0.017）,but no statistically significant differences between the control group and the intervention group A and the intervention group B（P>0.017）.There were no significant differences in the incidence of ventilator-associated pneumonia,pneumothorax and intracranial hemorrhage among the three groups（P>0.05）.There was no significant difference in the incidence of adverse reactions（skin pressure injury,tracheal catheter displacement,hemodynamic disorder,gastric reflux/aspiration,and corneal injury）among the three groups（P>0.05）.4.Comparison of arterial blood gas indexes in premature infants:1d,2d,and 3d after enrollment,there were statistically significant differences in Pa O₂ between control group and intervention group B（P<0.017）,but there were no statistically significant differences between control group and intervention group A or between intervention group A and intervention group B（P>0.017）.2d and 3d after enrollment,Pa CO₂ in control group was significantly different from that in intervention group A and intervention group B（P<0.017）,while there was no significant difference between intervention group A and intervention group B（P>0.017）.1d,2d and 3d after enrollment,there were statistically significant differences in OI between control group and intervention group B（P<0.017）,but no statistically significant differences between control group and intervention group A or intervention group A and intervention group B（P>0.017）.2d after enrollment,RI of the control group was compared with that of the intervention group B,and there was statistically significant difference（P<0.017）,but there was no statistically significant difference between the control group and the intervention group A,or the intervention group A and the intervention group B（P>0.017）.Three days after enrollment,RI in the control group was significantly different from that in the intervention group A and B（P<0.017）,while there was no significant difference between the intervention group A and the intervention group B（P>0.017）.5.Comparison of vital signs of premature infants:Heart rate immediately in prone position and 15min,30min and 60min after prone position:compared with intervention group A and intervention group B,there was statistically significant difference in heart rate of premature infants（P<0.017）,but there was no statistically significant difference between intervention group A and intervention group B（P>0.017）.Respiratory frequency and blood oxygen saturation at prone position immediately,15min,30min and 60min after prone position:compared with intervention group A and B,there were statistically significant differences in premature infants’respiration（P<0.017）,but there were no statistically significant differences between intervention group A and intervention group B（P>0.017）.Respiration rate and blood oxygen saturation 120min after prone position:there were statistically significant differences between control group and intervention group B,between intervention group A and intervention group B（P<0.017）,but no statistically significant differences between control group and intervention group A（P>0.017）.6.Comparison of comfort level of premature infants:Compared with the control group and the two intervention groups,the difference in the comfort level of premature infants was statistically significant（P<0.017）,but the difference between the two intervention groups was not statistically significant（P<0.017）.Conclusions1.Intermittent prone position during the non-invasive mechanical ventilation of premature infants can shorten the time of non-invasive mechanical ventilation,oxygen therapy and hospitalization.2.The duration of each prone position ventilation is 2h,which can improve the success rate of weaning and reduce the incidence of bronchopulmonary dysplasia.3.Prone ventilation does not increase the risk of adverse reactions during mechanical ventilation,and is an effective and safe adjuvant therapy.4.The prone position can help improve the breathing efficiency of premature infants,stabilize the breathing rate and heart rate,and make them in a more comfortable and stable physical and mental state.