Analysis Of The Effect Of Noninvasive Respiratory Support After Invasive Ventilation Extubation Of Respiratory Distress Syndrome In Premature Infants

ObjectiveThrough the analysis of the clinical data of the treatment of respiratory distress syndrome in preterm infants after invasive ventilation extubation by nasal intermittent positive pressure ventilation and nasal continuous positive pressure ventilation,Provide theoretical basis for better guiding clinical treatment.MethodFrom January 2017 to December 2019,a total of preterm infants who were born in our hospital within 6 hours and diagnosed Neonatal Respiratory Distress Syndrome with a gestational age of 28-32 weeks were included in the randomized controlled study.According to the clinical characteristics of the children and the first use of noninvasive ventilation mode after extubation of invasive ventilation,they were divided into NCPAP group or NIPPV group（twins were included in the same group,no cross treatment was conducted between the two groups）.Collect general data,Include:Gestational age,sex,body temperature,birth weight,delivery mode,Alzheimer’s score（1 minute and5 minutes）,amount of pulmonary surfactant,prenatal hormone use of the mother and weight growth rate;Analysis of arterial blood gas 0 hours before extubation,1 hour、6 hours、24 hours and 48 hours after extubation（Start using noninvasive ventilation mode）.To compare the p H,Pa CO₂,Pa O₂and Fi O₂of the two noninvasive ventilation modes,the failure rate of extubation,the rate of re-intubation,the time of invasive ventilation,the time of noninvasive ventilation,the total hospitalization time and the incidence of complications（BPD,ROP,PDA,NEC,ICH,etc.）during hospitalization were compared between the two groups.Results1.A total of 58 children with a gestational age of 28-32 weeks and diagnosed with neonatal respiratory distress syndrome were included in this study,Respectively,The NCPAP group were 31,and NIPPV group were 27.2.In the inter group comparison,there was no significant difference between the two groups in gestational age,sex,birth weight,delivery mode,prenatal hormone use,PS dosage,ASG（1 min and 5 min）and weight growth rate（P>0.05）.There was no significant difference in p H value when1,6,24,48 hours after extubation and before extubation between the two groups（P>0.05）.There was no significant difference in Pa CO₂before extubation between the two groups（P>0.05）.In NIPPV group,Pa CO₂decreased more than NCPAP,but Pa CO₂at 1,6,24 and 48 hours after extubation was no significant（P>0.05）;Pa O₂at 1 hour 6 hours,24 hours after extubation and before extubation was no significant difference（P>0.05）.The Pa O₂of 48 hours after extubation was statistically significant（P<0.05）,the Pa O₂of NIPPV group was higher than that of NCPAP group.Fi O₂in NIPPV group was lower than that in NCPAP group at 6hours after extubation（P<0.05）.3.Intra group comparison,in NCPAP group Pa O₂at 6 hours after extubation compared with 24 hours after extubation and 24 hours after extubation compared with 48 hours after extubation was statistically significant difference（P<0.05）,6 hours after extubation compared with 48 hours after extubation was no significant（P>0.05）.In NIPPV group Pa O₂at 6 hours after extubation compared with 24 hours after extubation and 24 hours after extubation compared with 48 hours after extubation was statistically significant（P<0.05）,6hours after extubation compared with 48 hours after extubation was no significant（P>0.05）.4.Intra group comparison,Comparison different time points in the one group,Pa O₂and Fi O₂were both decreased in two group,and Pa O₂increased in 6and 24 hours after extubation.5.There was no significant difference between the two groups in re-intubation rate,extubation failure rate,invasive ventilation time,noninvasive ventilation time and total hospitalization time.6.There was no significant difference in the incidence of complications（BPD,ROP,PDA,ICH,NEC and apnea,etc.）between the two groups,means there were no statistical difference after statistical treatment.Conclusion1.Both NIPPV and NCPAP can significantly improve pulmonary oxygenation and ventilation function of premature infants with respiratory distress syndrome after invasive ventilation extubation,The clinical application value of two ventilation modes in neonatal respiratory distress syndrome is positive.2.The Pa O₂level of NIPPV group after invasive ventilation extubation was higher than that of NCPAP group,And in NIPPV group,the decrease of Pa CO₂was greater than that of NCPAP group.3.NIPPV has no significant advantage over NCPAP in reducing the incidence of complications,it is a safe and effective noninvasive ventilation mode.