Nasal Intermittent Positive Pressure Ventilation For The Treatment Of Neonatal Respiratory Distress Syndrome

Objective: Neonatal respiratory distress syndrome (NRDS) after birthdue to lack of lung surfactant (PS), causing alveolar collapse the occurrence ofchronic progressive dyspnea, cyanosis, moaning and other acuterespiratorydistress and respiratory failure. NRDS children are morecommonner in premature children, low birth weight children or electiveCaesarean child. Pulmonary surfactant reduces alveolar surface tension, tomaintain the role of expiratory alveolar open, the lack of increase in alveolarsurface tension, and the inspiratory pressure must be increased to ensureadequate ventilation, resulting in breathing difficulties and other clinicalmanifestations. Alveolar collapse, ventilation, ventilation and perfusion bloodflow more than offset, resulting in hypoxemia and carbon dioxideaccumulation, lung tissue hypoxia, increased capillary permeability, fibrincalm hyaline membrane formation in the alveolar surface, which seriouslyimpedes gas exchange.At present NRDS clinical treatment of the key measures: on the one handapplication lung surface active substances replacement therapy, on the otherhand as soon as possible to solve the mechanical ventilation alveolar trappedand accumulation of oxygen. Tracheal intubation NRDS mechanical entilationapplications, it can quickly improve hypoxia, solve the alveolar witheringtrapped problem, but the ventilation easy to cause the laryngeal edema, gasleak, and pulmonary infection and chronic lung diseases andentilator-associated pneumonia, even some breathing machine dependentchildren appear, and medical treatment fee expensive. In recent years, no andassisted ventilation in the treatment of the curative effect of NRDS are gettingmore and more attention to. Domestic and foreign research reported no andassisted entilation can not only play the role of the alveolar expansion, to a certain extent reduced the incidence of complications related to themechanical ventilation and mortality.In recent years the application of nasal continuous positive airwaypressure (NCPAP) treatment of neonatal respiratory distress syndrome athome and abroad, the NRDS there are more reports, especially in reducingintubation invasive ventilation caused lung injury, infection andbronchopulmonary dysplasia has a good effect, but NCPAP caused byabdominal distension, CO₂retention, open milk time delay and a higherre-intubation, application of invasive ventilation is all the focus of attention.nasal intermittent positive pressure ventilation (NIPPV) in based on anincrease of a certain frequency of intermittent positive pressure, and increasedtidal volume and minute ventilation, mean airway pressure, lung capacity andsupport alveolar expansion, and increased gas exchange, compared withNCPAP has more breathing support role.By researching the children to NRDS application NIPPV and NCPAPafter treatment, observe lung expansion and spontaneous breathing changedsituation, blood gas analysis and oxygen concentration changes, the lungfunction and improve oxygen, mechanical ventilation and oxygen cure timetime, once again, computer ratio and a variety of intubation complications arediscussed, NIPPV compared with NCPAP the clinical curative effect of thetreatment, and for the next NIPPV technology safety, clinical treatment effectand application prospects provide more basis.Methods:1. The object of study:Selection of Hebei Children's Hospital neonatology intensive care unitfrom January2010to November2011were the diagnosis of neonatalrespiratory distress syndrome of the newborn, gestational age in the29-35w,weight0.90-2.25kg. Neonatal respiratory distress syndrome the Jin Han Zhenedited practical neonatal study the2004diagnostic criteria. Neonatalrespiratory distress syndrome in children will be selected randomly into theNIPPV group and the NCPAP group. There were32children in the NIPPV group, including18males and14females; of which15cases of cesareansection, vaginal delivery, and17cases of double fetus of six cases. Gestationalage (GA) is31.77±2.35weeks; birth weight (BW) is1.43±0.30(kg). Therewere34children in the NCPAP group of34, including21males and13females; of which18cases of cesarean section,16cases of natural childbirth,double fetus of eight cases. Gestational age is32.43±2.02weeks, birth weightis1.38±0.29(kg).The two groups of children selected before family members signedinformed consent to treatment and informed consent were adopted by theHebei Children's Hospital Ethics Committee.2. Research methods:Selected children admitted to hospital immediately after giving NIPPV orNCPAP treatment of ventilator start time is recorded as0h. Domestic bovinelung surfactant70mg/kg (Beijing Double-Crane Pharmaceutical production)children are given within12hours after birth, rapid injection of a one-time bytracheal intubation, immediately after treatment pull tracheal intubation tocontinue non-invasive ventilatory support.6hours after treatment,12hourslater chest radiograph. NIPPV group VIP BIRD, baby breathing machine,choose a size suitable for Hudson prongs on nasal congestion. The NCPAPGroup EME produced by UK INFANT the FLOW SYSTEM ventilator. Thetwo groups of children based on clinical and blood gas analysis results in atimely manner, the adjustment of ventilator parameters to maintain the PaO₂50-80mmHg, PaCO₂was40-55mmHg, PH7.25-7.40, TcSPO₂between88%-93%.3. The treatment effect:Ventilator weaning standard:(1) NIPPV group ventilator weaningindications: the NIPPV breathing machine parameters reduce after treatmentto PIP10cmH2O, PEEP3cmH2O, RR10times/seconds, FiO₂<25%; Childrenand clinical manifestation chest radiograph better, TcSPO₂and blood gasanalysis to normal.(2) NCPAP group ventilator weaning indications: theNCPAP breathing machine parameters reduce after treatment to CPAP pressure3cmH2O, FiO₂<25%; Children and clinical manifestation chestradiograph better, TcSPO₂and blood gas analysis to normal.Tracheal intubation mechanical ventilation indications:(1) Children didnot improve or worsen breathing difficulties, or chest X-ray lesions no better;(2) FiO₂>60%to maintain the TcSaO₂in above88%;(3) Appear type IIrespiratory failure;(4) In other circumstances of illness, such as pulmonaryhemorrhage, tension pneumothorax, and so on. Have the above situation giventracheal intubation ventilation mode.4. Observe the index:Admitted to hospital after treatment time of0h,12h after treatment,24hand72h since the radial artery blood do blood gas analysis and understandingof PaO₂, PaCO₂changes; dynamic observation of percutaneous oxygensaturation and oxygen concentration changes. Record each time point, childrenwith blood gas analysis results, the transcutaneous oxygen saturationmonitoring values and inspired oxygen concentration, and calculate the P/Fa/APO₂value. Records two groups of children with chest X-ray changes inthe course of supplemental oxygen, ventilator time, feeding time, re-intubationon the occurrence and clinical outcomes, complications were observed.5. Statistics analysis:All data to clean, summarizing and SPSS13.0statistical software forstatistical processing, the measurement data of normal sexual inspection andvariance of all inspection, normal distribution and variance of sexual materialtogether, the mean±standard deviation (plus or minus) said; Count betweentwo groups compare and data set the rate compares the chi-square test. Twogroups of children of the different time points of the index changes the singlefactor analysis of variance (ANOVA), compares the two in the group twoSNK-q inspection, two groups corresponding time points between the change ttest, P<0.05for differences with a statistical significance.Results:1. The general situation in childrenWhen the two groups of children admitted to hospital: the time of birth weight, gestational age, the transporter admission time, raw application ofpulmonary surfactant, the ratio of male to female, mode of delivery, doublefetus, children with weight distribution of the two groups and II degree IIIdegree the NRDS distribution of the differences were not statisticallysignificant (P>0.05).2. Comparison of PaO₂and PaCO₂between NCPAP and NIPPVWhen treatment is started two sets of blood gas the PaO₂and PaCO₂difference not statistically significant (P>0.05). Treatment of12h,24h,72hafter the two groups of the PaO₂and PaCO₂showed some improvements (P<0.05) at all time points in the group difference was statistically significant (P<0.05). Between the two groups compared with the NIPPV group to improvethe situation better than NCPAP group, the difference was statisticallysignificant (P <0.05).3. Comparison of P/F and a/APO₂between NCPAP and NIPPVThe two groups of children0:00P/F, a/APO₂differences not statisticallysignificant (P>0.05). Treatment of12h,24h72hours after the P/F, a/APO₂both improved at all time points in the group difference was statisticallysignificant (P<0.05). The two groups compared with the NIPPV groupcompared with NCPAP group improved more significantly, the difference wasstatistically significant (P <0.05).4. Two sets of breathing machine to use oxygen therapy spend more timeNIPPV group oxygen therapy time and computer time were significantlyshorter than the NCPAP group, the difference was statistically significant (P<0.05). Using PS6hours after the review of chest radiograph, the differencewas not statistically significant (P>0.05), again review the chest X-ray after12hours of NIPPV group improved compared with NCPAP group, thedifference was statistically significant (P <0.05).5. Comparison of complications and outcomeThe two groups of children with CO₂retention, abdominal distension anda ratio difference was statistically significant (P<0.05), and the NIPPV groupto open the milk compared to NCPAP group in advance. NIPPV group changed to intubation and ventilator rate after nasal airway treatment failurewas significantly lower than NCPAP group, the difference was statisticallysignificant (P <0.05), two sets of death and give up after the death ratio and airleak, nasal injury, the rate of intracranial hemorrhage was no significantdifference (P>0.05).Conclusion:1. Two groups of noninvasive ventilation modes of treatment with type IIcalled NRDS decline of good treatment effect, and can significantly improveoxygen close, improve lung oxygen and function.2. NIPPV in treatment is the advantage of NRDS NCPAP, in a short timecan obviously improve the oxygen and lung function, increase oxygensaturation, reduce oxygen concentration, to avoid the carbon dioxide retention,make little patient clinical symptoms ease.3. Compared to NCPAP application the NRDS children of NIPPVtreatment are shorter the noninvasive assisted entilation time and oxygen curetime, improve the life quality of children.3. NRDS children NIPPVapplication is NCPAP application compared treatment, shorten thenoninvasive assisted entilation time and oxygen cure time, improve the lifequality of children.4. NIPPV group PaCO₂retention, abdominal distension children wassignificantly lower than the incidence of NCPAP group, and feeding childrentime in advance, intracranial hemorrhage, gas leak, nose injury, death and giveup the incidence of death after there is no difference between the two groups.NCPAP group therapy failed to tracheal intubation breathing machine washigher than the rate NIPPV group.