高海拔地区新生儿呼吸衰竭的无创呼吸机治疗：一项随机对照试验
Noninvasive Ventilator Therapy for Neonatal Respiratory Failure at High Altitude: A Randomized Controlled Trial
DOI: 10.12677/acm.2025.15123522, PDF,    科研立项经费支持
作者: 徐本伟*：重庆医科大学附属儿童医院新生儿科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，重庆；儿童代谢与炎症性疾病重庆重点实验室，重庆；徐文鸽*, 杨娅丽, 方海琴, 张伟丽, 张安鹏, 李红红, 陆小倩, 赖小敏, 刘 虎, 向巴曲西, 徐晨霞, 汤 冰：昌都市人民医院儿科，西藏 昌都；梁跃波：昌都市人民医院儿科，西藏 昌都；重庆黔江中心医院新生儿科，重庆；王永明#：重庆医科大学附属儿童医院新生儿科，国家儿童健康与疾病临床医学研究中心，儿童发育疾病研究教育部重点实验室，重庆；昌都市人民医院儿科，西藏 昌都
关键词: 新生儿呼吸衰竭；高原地区；无创呼吸支持；Neonatal Respiratory Failure； High Altitude； Noninvasive Respiratory Support
摘要: 目的：本研究比较高海拔地区新生儿呼吸衰竭采用经鼻间歇正压通气(NIPPV)和经鼻持续气道正压通气(NCPAP)的临床效果。我们旨在为改善高海拔缺氧环境下新生儿呼吸管理的临床指南提供证据。方法：本研究为单中心随机对照试验，于2022年5月至2023年12月进行。患有新生儿呼吸窘迫综合征(NRDS)和重症肺炎的新生儿被随机分配至NIPPV组(实验组)或NCPAP组(对照组)。主要结局指标为插管率和再次气管插管率。次要结局指标包括支气管肺发育不良(BPD)的发生率、死亡率和其他并发症。结果：在重症肺炎组中，与NCPAP相比，NIPPV显著降低了插管率(15.0% vs. 37.5%, OR = 3.400, 95% CI: 1.150~9.996, P = 0.022)和再次气管插管率(7.5% vs. 25%, OR = 4.111, 95% CI: 1.037~16.295, P = 0.034)。在NRDS组中，NIPPV显著降低了插管率(17.5% vs. 40%, OR = 3.143, 95% CI: 1.120~8.822, P = 0.026)和再次气管插管率(12.5% vs. 32.5%, OR = 3.170, 95% CI: 1.070~10.613, P = 0.032)。次要结局指标无显著差异。结论：与NCPAP相比，NIPPV显著降低了插管和再次气管插管的风险。这些发现对于指导高海拔缺氧环境下的新生儿呼吸管理至关重要。
Abstract: Objective: This study compared the clinical effects of nasal intermittent positive pressure ventilation (NIPPV) and nasal continuous positive airway pressure (NCPAP) on neonatal respiratory failure at high altitude. We aimed to provide evidence for improving clinical guidelines for neonatal respiratory management in high-altitude hypoxia. Methods: A single-center, randomized controlled trial was conducted from May 2022 to December 2023. Newborns with Neonatal Respiratory Distress Syndrome (NRDS) and severe pneumonia were randomly assigned to NIPPV (experimental) or NCPAP (control). Primary outcomes were intubation and re-intubation rates. Secondary outcomes included the incidence of bronchopulmonary dysplasia (BPD), mortality, and other complications. Results: In the severe pneumonia group, NIPPV significantly reduced intubation rates compared to NCPAP (15.0% vs. 37.5%, OR = 3.400, 95% CI: 1.150~9.996, P = 0.022) and re-intubation rates (7.5% vs. 25%, OR = 4.111, 95% CI: 1.037~16.295, P = 0.034). In the NRDS group, NIPPV significantly reduced intubation rates (17.5% vs. 40%, OR = 3.143, 95% CI: 1.120~8.822, P = 0.026) and re-intubation rates (12.5% vs. 32.5%, OR = 3.170, 95% CI: 1.070~10.613, P = 0.032). No significant differences were observed in secondary outcomes. Conclusion: NIPPV significantly reduced the risk of intubation and re-intubation compared to NCPAP. These findings are crucial for guiding neonatal respiratory management in high-altitude hypoxia.
文章引用：徐本伟, 徐文鸽, 杨娅丽, 梁跃波, 方海琴, 张伟丽, 张安鹏, 李红红, 陆小倩, 赖小敏, 刘虎, 向巴曲西, 徐晨霞, 汤冰, 王永明. 高海拔地区新生儿呼吸衰竭的无创呼吸机治疗：一项随机对照试验[J]. 临床医学进展, 2025, 15(12): 1216-1226. https://doi.org/10.12677/acm.2025.15123522

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