目的比较鼻式间歇正压通气（nasal intermittent positive pressure ventilation，NIPPV）和鼻式持续气道正压通气（nasal continuous positive airway pressure，NCPAP）用于新生儿呼吸窘迫综合征（respiratory distress syndrome，RDS）机械通气后预防拔管失败的效果。方法计算机检索Cochrane图书馆数据库、PubMed数据库、EBASE数据库、Ovid数据库和Springer数据库、中国期刊全文数据库、万方数据库和维普中文科技期刊数据库，获得有关NIIPPV与NCPAP治疗RDS的随机对照临床试验（RCT）文献，检索2012年12月以前的文献，对检索到的文献进行质量评价，纳入的文献采用RevMan5.1软件进行荟萃分析。结果6篇RCT文献进入Meta分析，结果显示NIIPPV组脱机成功率高于NCPAP组（OR值为0.19，95%可信区间0.07~0.52，P=0.001）。NIIPPV组早产儿脑损伤（IVH+PVL）发病率小于NCPAP组（OR为0.46，95%可信区间0.22~0.97，P=0.04）。NIIPPV组和NCPAP组BPD发生率（OR=0.65，95%CI0.40~1.06）、ROP发生率（OR=0.83，95％CI0.16~4.42）、鼻部损伤发生率（OR=0.86，95％CI0.40~1.83）、胃肠道疾病并发症发生率（OR=0.72，95％CI0.45~1.16）差异均无统计学意义。结论 NIPPV可减少早产儿RDS机械通气后拔管失败率，安全有效。%Objective To assess the efficacy of nasal intermittent positive pressure ventilation(NIPPV)vs nasal continuous airway positive pressure(NCPAP)as preventing extubation failure after mechanical ventilation in premature infants with RDS. Methods Randomized controlled trials(RCTs)that comparing NIPPV with nasal continuous airway positive pressure(NCPAP)for extubation were searched inCorhrane library,PubMed,EMBase,Ovid,Springer,CNKI,Wanfang and VlP database etc(till December 2012).The quality of the included RCTs was evaluated,and Meta-analysis was performed with ReMan5.1software. Results Six trials was included,Infants treated with NIPPV had lower incidence of extubation failure (OR=0.19,95%CI:0.07~0.52,P=0.001)and brain injury(OR=0.46,95%CI:0.22~0.97,P=0.04)than those treated with NCPAP.there was no significant incidence reduction in BPD(OR=0.65,95%CI:0.40~1.06),ROP(OR=0.83,95%CI:0.16~4.42),nasal injury(OR=0.86,95%CI:0.40~1.83)and gastrointestinal complication(OR=0.72,95%CI:0.45~1.16).Conclusions NIPPV is safe and feasible for preventing extubation failure in infants with RDS and more effective than NCPAP,but larger sample size RCTs are needed to confirm these effects.
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