湿化高流量鼻导管通气治疗早产儿反复发作性呼吸暂停的临床研究

The effects of humidified high flow nasal cannula therapy on recurrent apnea in premature infants

目的比较湿化高流量鼻导管通气(HHFNC)与鼻塞式持续气道正压通气(NCPAP)应用于早产儿反复发作性呼吸暂停的临床疗效。方法选取2014年5月至2015年12月我院新生儿科收治的反复发作性呼吸暂停早产儿,随机分为HHFNC组和NCPAP组,接受氨茶碱等综合治疗后分别应用HHFNC和NCPAP辅助治疗。观察两组患儿的治疗效果、血气分析、临床症状改善情况及不良反应发生率。结果 HHFNC组及NCPAP组各40例,两组患儿的分娩方式、胎龄、性别、出生体重、1 min Apgar评分、首次出现呼吸暂停时间比较差异均无统计学意义(P>0.05)。HHFNC组和NCPAP组治疗总有效率分别为87.5%和80.0%,差异无统计学意义(P>0.05)。两组患儿0 h PaO_2、PaCO_2、a/APO_2比较差异无统计学意义(P>0.05);两组治疗后12、24 h的PaO_2、PaCO_2、a/APO_2较0 h均明显改善,差异有统计学意义(P<0.05),两组间比较差异无统计学意义(P>0.05)。与NCPAP组相比,HHFNC组开奶时间及达全肠道喂养时间提前,鼻部损伤、腹胀发生率明显降低,差异均有统计学意义(P<0.05)。两组氧疗时间、无创通气时间、接受有创辅助通气例数、坏死性小肠结肠炎、动脉导管未闭、支气管肺发育不良、早产儿视网膜病发生率比较差异均无统计学意义(P>0.05)。结论 HHFNC治疗早产儿反复发作性呼吸暂停的作用与NCPAP相当,但HHFNC能使开奶时间及达全肠道喂养时间提前,并降低鼻部损伤和腹胀的发生率。

Objective To compare the clinical efficacy between humidified high-flow nasal cannula（ HHFNC） ventilation and nasal continuous positive airway pressure（ NCPAP） in the treatment of recurrent apnea of premature infants. Methods Preterm infants with recurrent apnea were randomly assigned into HHFNC group and NCPAP group after receiving aminophylline and conventional treatment.The changes in clinical symptoms,blood gas analysis,and the incidence of adverse events were observed between the two groups. Results Forty patients were enrolled in each group. The delivery mode,gestational age,gender,birth weight,1 min Apgar score and the occurrence of the first apnea between the two groups were compared,and no significant differences existed（ P〈0. 05）. The overall effective rate of HHFNC and NCPAP were 87. 5% and 80. 0%,respectively; the difference was not statistically significant（ P〈0. 05）. No statistical significant differences existed in PaO2,PaCO2 and a / APO2 between the two groups（ P〈0. 05） at the beginning of treatment（ 0 h）. PaO2,PaCO2 and a / APO2at12 h and 24 h after the treatment showed significant improvement in both two groups without significant differences（ P〈0. 05）. Comparing with NCPAP group,HHFNC group had significantly shorter time to achieve first feeding and total enteral feeding,lower incidences of nasal injuries and abdominal distension（ P〈0. 05）. The duration of oxygen therapy and non-invasive ventilation,the percentage of infants needing invasive ventilation, the incidences of necrotizing enterocolitis, patent ductus arteriosus,bronchopulmonary dysplasia and retinopathy between the two groups showed no differences（ P〈0. 05）.Conclusions HHFNC has the same effect with NCPAP in the treatment of recurrent apnea in premature infants. However,HHFNC group can achieve first feeding and total enteral feeding earlier,and has lower incidence of nasal trauma and abdominal distension.