高流量鼻导管湿化氧疗在新生儿肺炎并呼吸衰竭中的应用

The application of humidified high flow nasal cannula for neonatal pneumonia with respiratory failure

目的探讨高流量鼻导管湿化氧疗(HHFNC)在新生儿肺炎并呼吸衰竭中的临床应用效果。方法回顾性分析2012年1月至2013年10月我院新生儿科收治、未达到机械通气指征的新生儿肺炎并呼吸衰竭患儿。根据治疗方法分为HHFNC组、普通吸氧组(对照组)和经鼻持续气道正压通气(CPAP)组。比较各组治疗效果,治疗前、治疗后12 h、24 h PaO2、PaO2/FiO2、呼吸频率等指标,以及患儿主要症状体征消失时间和住院时间。结果 HHFNC组(32例)治疗有效率高于对照组(25例)(87.5%比56.0%,P<0.05),与CPAP组(36例)相近(81.5%比91.1%,P>0.05);HHFNC组和CPAP组治疗后气促、三凹征、肺部啰音消失的时间及平均住院天数较对照组明显缩短(P<0.01),HHFNC组和CPAP组差异无统计学意义(P>0.05);HHFNC组治疗12 h、24 h后PaO2、PaO2/FiO2升高,呼吸频率减慢,与对照组比较差异有统计学意义(P<0.05),与CPAP组比较差异无统计学意义(P>0.05)。结论 HHFNC治疗新生儿肺炎并呼吸衰竭有显著疗效,损伤小,是一种适宜的新生儿无创呼吸支持技术。

Objective To explore the clinical efficacy of humidified high flow nasal carnula （HHFNC） for neonatal pneumonia with respiratory failure. Methods A total of 93 neonates from the department of neonatology from January 2012 to October 2013, who did not meet the requirement for mechanical ventilation, participated in the retrospective study. They were divided into HHFNC group （ n = 32） and normal oxygen control group （ n = 25 ） and CPAP group （ n = 36）. Treatment results, blood gas changes, respiratory frequency at 12h and 24h post treatment, time for resolution of clinical signs and duration of hospital stay, were compared. Results The treatment efficacy of the HHFNC group compared to control group was higher （ 28/32 vs. 14/25, P 〈 O. 05 ）, which was similar to the CPAP group （28/32 vs. 33/36 ,P 〉0. 05）. There was shorter duration for clinical signs and hospital stay in the HHFNC and CPAP groups compared the control group （P 〈 0. 01 ） . PaO2 and PaO2/FiO2 were significantly higher and respiratory frequency was significantly lower for the HHFNC group compared to the control group at 12 h and of 24 h post treatment. （both P 〈 0. 05 ）, and was similar to the CPAP group （P 〉 0. 05 ）. Conclusions The application of HHFNC for neonatal pneumonia with respiratory failure is efficacious and is a suitable newborn noninvasive respiratory support technology.