湿化高流量鼻导管通气在极低出生体质量儿呼吸暂停中的应用

Application of Humidified High Flow Nasal Cannula on Apnea in Very Low Birth Weight Infant

目的:探讨湿化高流量鼻导管通气(HHFNC)治疗极低出生体质量儿呼吸暂停的效果。方法:选取住院期间出现呼吸暂停的极低出生体质量儿作为研究对象,在使用枸橼酸咖啡因的基础上,随机分为两组,HHFNC组给予湿化高流量鼻导管通气,n CPAP组给予经鼻持续正压通气,比较两组间动脉血气分析变化、治疗有效率、尿量、血压的改变及无创机械通气时间、并发症的发生率。结果:经治疗后两组氧合均明显改善;HHFNC组在治疗6 h、12 h、24 h、48 h后二氧化碳分压的改善情况优于n CPAP组(Ffactor=14.253,P<0.01),且鼻黏膜的损伤、喂养不耐受的发生率较n CPAP组低(P<0.05);HHFNC组治疗后尿量增加(P<0.01);两组有效率比较差异无统计学意义(P>0.05);两组无创机械通气时间、气漏、低血压、新生儿坏死性小肠结肠炎、脑损伤(颅内出血、早产儿脑室周白质软化)、支气管肺发育不良发生率比较差异均无统计学意义(P>0.05)。结论:HHFNC可作为一种有效的无创呼吸支持模式治疗早产儿呼吸暂停,喂养不耐受及鼻黏膜损伤发生率相对较低,可提高治疗的耐受性。

Objective： To investigate the application of humidified high flow nasal cannula（HHFNC） on apnea in very low birth weight infant. Methods： Very low birth weight infants who developed apnea during the period of hospitalization were enrolled as objects.Based on the use of caffeine citrate,they were randomly divided into 2 groups,combined either with the application of HHFNC,or the nasal continuous positive airway pressure（n CPAP）,the arterial blood gas analysis,the therapeutic effect rate,changes in urine volume and blood pressure, the duration of non-invasive ventilation and the incidence of complications were compared. Results： The oxygenation of the two groups were significantly improved after treatment. The improvement of the carbon dioxide partial pressures of HHFNC group were better than the n CPAP group after treatment at the time of 6,12,24,48 h（Ffactor= 14. 253,P〈0. 01）. The occurrence of nasal mucosa injury,feeding intolerance were lower in HHFNC group than those in n CPAP group（P〈0. 05）. Urine volume was increased after treatment in HHFNC group（P〈0. 01）. No significant difference was found between two groups in the total therapeutic effect rate（P〉0. 05）. No significant differences were found between the two groups in the duration of non-invasive ventilation,air leakage,hypotension,neonatal necrotizing enterocolitis,brain injury（intracranial hemorrhage,periventricular leukomalacia）,and bronchopulmonary dysplasia（P〉0. 05）. Conclusion： HHFNC can be used as an effective noninvasive respiratory support mode for the treatment of apnea,for premature infant,the incidence of feeding intolerance and nasal mucosa injury is relatively low,which can improve the treatment tolerance.