高流量鼻导管湿化氧疗治疗新生儿重症肺炎的临床研究

Clinical study of humidified high flow nasal cannula in neonatal with severe pneumonia

目的 探讨高流量鼻导管湿化氧疗（HHFNC）对新生儿重症肺炎的治疗效果.方法 将42例新生儿重症肺炎患儿根据治疗方法不同分为治疗组20例和对照组22例,治疗组给予HHFNC治疗；对照组给予经湿化瓶鼻导管或面罩给氧治疗.比较两组患儿主要症状体征消失时间、住院时间及治疗组HHFNC应用前后脉搏血氧饱和度（SpO2）、动脉血氧分压（PaO2）、动脉血二氧化碳分压（PaCO2）、呼吸频率等指标的改善情况.结果 治疗组有效率显著高于对照组[90.00％（18/20）比63.64％（14/22）],差异有统计学意义（P＜0.05）.治疗组主要症状体征消失时间及住院时间明显短于对照组,机械通气率较对照组明显降低[10.00％（2/20）比45.45％（10/22）],差异均有统计学意义（P＜0.05）；HHFNC应用后12,24 h和撤离HHFNC后1h的SpO2及PaO2均较HHFNC应用前显著升高[0.921±0.027,0.955±0.021,0.958±0.016比0.865±0.045,（83.4±28.3）,（89.8±20.4）,（92.8±12.6） mmHg（1mmHg =0.133 kPa）比（52.8±10.1） mmHg],HHFNC应用后24h及撤离HHFNC后1 h PaCO2较HHFNC应用前显著降低[（46.1±6.3）,（43.7± 7.2） mmHg比（59.7±8.3） mmHg],差异均有统计学意义（P＜0.05）.呼吸频率随治疗时间点的推移进行性下降,差异均有统计学意义（P＜0.05）.结论 应用HHFNC治疗新生儿重症肺炎疗效确切,值得推广.

Objective To explore the effect of humidified high flow nasal cannula （HHFNC） in neonatal with severe pneumonia.Methods Forty-two cases of neonatal with severe pneumonia according to different treatment methods were divided into treatment group （20 cases） and control group （22 cases）.Treatment group was given HHFNC,control group was given the wet bottle oxygen nasal cannula or mask.Disappearance of symptoms and hospital stay in two groups,blood oxygen saturation （SpO2）,partial pressure of oxygen （PaO2）,partial pressure of earbondioxidc （PaCO2） and respiratory rate in treatment group before and after the application of HHFNC were compared.Results The effective rate in treatment group was significantly higher than that in control group [90.00% （18/20） vs.63.64% （14/22）],which reached statistical significance （P 〈0.05）.Disappearance of symptoms and hospital stay in treatment group were shorter than those in control group,and mechanical ventilation rate was lower than that in control group [10.00%（2/20） vs.45.45%（10/22）],which reached statistical significance （P 〈 0.05）.SpO2 and PaO2 at application of HHFNC after 12,24 h and 1 h after evacuation of HHFNC were significantly increased eompared with those before [0.921 ± 0.027,0.955 ± 0.021,0.958 ± 0.016 vs.0.865 ± 0.045; （83.4 ± 28.3）,（89.8 ±20.4）,（92.8 ±12.6） mmHg （1 mmHg =0.133 kPa） vs.（52.8 ±10.1） mmHg],PaCO2 at application of HHFNC after 24 h and 1 h after evacuation of HHFNC were significantly reduced compared with those before [（46.1 ±6.3）,（43.7 ±7.2） mmHg vs.（59.7 ± 8.3） mmHg],which reached statistical significance （P 〈0.05）.Respiratory rate was decreased with the treatment time,which reached statistical significance （P〈 0.05）.Conclusion Application of HHFNC in neonatal with severe pneumonia is effective and woorth promoting.