无创高频振荡通气对早产儿呼吸窘迫综合征的临床疗效

Clinical efficacy of noninvasive high-frequency oscillation ventilation in premature infants with respiratory distress syndrome

目的探讨无创高频振荡通气(nHFOV)对早产儿呼吸窘迫综合征(RDS)的临床疗效。方法将2017年3月至2020年3月诊断为RDS的200例早产儿分为研究组和对照组,每组各100例。研究组给予nHFOV进行治疗,对照组给予经鼻持续气道正压通气(nCPAP)治疗。对比两组患儿治疗后的疗效、初始治疗失败率、早产儿支气管肺发育不良(BPD)发生率、不良事件发生率、血气分析相关指标、振幅整合脑电图(aEEG)评分及血清高迁移族蛋白B1(HMGB1)水平。结果研究组患儿治疗后的疗效显著优于对照组患儿[93.00%(93/100)vs.63.0%(63/100),χ^(2)=68.923,P<0.001],且研究组患儿初始治疗失败率[6.00%(6/100)vs.15.00%(15/100),χ^(2)=4.310,P=0.038]及BPD发生率[1.00%(1/100)vs.9.00%(9/100),χ^(2)=6.737,P=0.009]均显著低于对照组,而两组患儿气胸/气漏、消化道穿孔、早产儿坏死性小肠结肠炎、早产儿视网膜病、颅内出血、鼻损伤、死亡的发生率比较,差异均无统计学意义(χ^(2)=2.083、2.909、0.977、1.332、1.047、0.521、2.750,P均>0.05)。同时,与对照组患儿比较,治疗后研究组患儿的氧分压[(89±28)mmHg vs.(80±29)mmHg,t=2.151,P=0.033]、二氧化碳分压[(37±7)mmHg vs.(41±10)mmHg,t=3.386,P<0.001]及血氧饱和度水平[(97.4±2.1)%vs.(90.6±6.4)%,t=10.049,P<0.001]均显著改善,aEEG评分显著升高[(8.5±1.5)分vs.(5.2±1.9)分,t=13.319,P<0.001],血清HMGB1水平显著降低[(578±71)ng/L vs.(628±72)ng/L,t=5.071,P<0.001]。结论nHFOV可有效改善RDS早产儿的脑功能、血气分析及呼吸支持相关指标,降低血清HMGB1水平,提升整体临床疗效。

ObjectiveTo evaluate the effect of noninvasive high-frequency oscillation ventilation(nHFOV)in premature infants with respiratory distress syndrome(RDS).MethodsA total of 200 premature infants with RDS from March 2017 to March 2020 were randomly divided into a research group and a control group,with 100 cases in each group.The research group was treated with nHFOV and the control group was treated with nasal continuous positive airway pressure.The effective rate,failure rate of initial treatment,incidence of bronchopulmonary dysplasia(BPD),incidence of adverse events,blood gas analysis related indicators,amplitude integrated electroencephalogram(aEEG)score and high mobility group protein B1(HMGB1)level were compared between the two groups.ResultsThe effective rate was much better in the research group than in the control group[93.00%(93/100)vs.63.0%(63/100),χ^(2)=68.923,P<0.001].The failure rate of initial treatment[6.00%(6/100)vs.15.00%(15/100),χ^(2)=4.310,P=0.038]and the incidence of BPD[1.00%(1/100)vs.9.00%(9/100),χ^(2)=6.737,P=0.009]in the research group were much lower than those in the control group.There was no significant difference in the incidence of adverse events such as pneumothorax/air leakage,gastrointestinal perforation,necrotizing enterocolitis,retinopathy of prematurity,intracranial hemorrhage,nasal injury and death between the two groups(χ^(2)=2.083,2.909,0.977,1.332,1.047,0.521,2.750;allP>0.05).The levels of partial pressure of oxygen[(89±28)mmHg vs.(80±29)mmHg,t=2.151,P=0.033],partial pressure of carbon dioxide[(37±7)mmHg vs.(41±10)mmHg,t=3.386,P<0.001]and oxygen saturation[(97.4±2.1)%vs.(90.6±6.4)%,t=10.049,P<0.001]significantly improved,the aEEG score remarkedly increased[(8.5±1.5)vs.(5.2±1.9),t=13.319,P<0.001],and the serum HMGB1 level obviously decreased[(578±71)ng/L vs.(628±72)ng/L,t=5.071,P<0.001]in the research group after treatment,as compared with the control group.ConclusionThe nHFOV can effectively improve brain function,blood gas indicators and respiratory support related indexes,reduce serum HMGB1 levels and enhance overall clinical efficacy in premature infants with RDS.