两种无创呼吸支持法治疗早产儿呼吸窘迫综合征疗效分析

Comparison of clinical efficacy of two noninvasive respiratory support therapy for respiratory distress syndrome in preterm infants

目的 探讨早期应用经鼻间歇正压通气（nasal intermittent positive pressure ventilation,NIPPV）与加温湿化经鼻导管高流量通气（heated humidified high flow nasal cannula,HHHFNC）治疗低出生体重呼吸窘迫综合征（respiratory distress syndrome,RDS）早产儿的临床疗效.方法 选择2015年5 ～ 12月本院出生并收治的低出生体重RDS早产儿,随机分为NIPPV组和HHHFNC组.分析两组患儿初始治疗失败率、肺表面活性物质（pulmonary surfactant,PS）使用率、呼吸支持治疗相关数据及各种并发症的发生率.结果 共纳入低出生体重RDS早产儿70例,胸部X线片均提示RDSⅠ～Ⅲ级,其中男33例,女37例;出生体重1 020～2 450 g,平均（1 845±475）g;NIPPV组和HHHFNC组各35例.NIPPV组治疗72 h内气管插管率、PS使用率、严重呼吸暂停发生率、肺炎比例、有创辅助通气时间及无创辅助通气时间均低于HHHFNC组[5.7％比11.4％、0％比8.6％、11.4％比14.3％、11.4％比14.3％、76.3（30.8,150.4）h比97.6（56.2,142.6）h、65.0（43.0,119.0）h比96.0（65.0,134.0） h],总用氧时间高于HHHFNC组[154.0（47.0,340.0）h比148.0（72.0,327.0）h],但差异均无统计学意义（P＞0.05）.两组支气管肺发育不良、颅内出血、早产儿视网膜病、坏死性小肠结肠炎、动脉导管未闭、鼻损伤、气胸等并发症发生率比较差异均无统计学意义（P＞0.05）.结论 HHHFNC作为初始呼吸支持治疗低出生体重RDS早产儿与NIPPV临床疗效相当,可能是供临床选择的另一种安全和有效的无创辅助通气治疗方式,值得临床进一步应用研究.

Objective To compare the clinical efficacy of nasal intermittent positive pressure ventilation （NIPPV） and heated humidified high flow nasal cannula （HHHFNC） in the treatment of respiratory distress syndrome （RDS） among low-birth-weight premature infants.Method From May to December 2015,low-birth-weight premature infants with RDS who were born and treated in our hospital were randomly assigned into NIPPV group and HHHFNC group according to their initial ventilation mode.The incidence of initial treatment failure,the usage of pulmonary surfactant （PS）,the parameters of respiratory support treatment and the incidence of complications were analyzed.Result A total of 70 cases with grade Ⅰ ～ llⅢ of RDS were included,including 33 males and 37 females.The birth weight ranged from 1 020 to 2 450 g,with a average of （1 845 ± 475） g.NIPPV and HHHFNC group each had 35 cases.No significant differences existed between the two group in the following items：the rate of mechanical intubation within 72 h （5.7% vs.11.4%）,use of PS （0% vs.8.6%）,incidence of severe apnea （11.4% vs.14.3%）,pneumonia （11.4% vs.14.3%）,the duration of invasive mechanical ventilation [76.3 （30.8,150.4） h vs.97.6 （56.2,142.6） h],non-invasive ventilation [65.0 （43.0,119.0） h vs.96.0 （65.0,134.0） h] and the duration of oxygen therapy [154.0 （47.0,340.0） h vs.148.0 （72.0,327.0） h,it was no （P 〉 0.05）.Also,no significant differences in the incidence of bronchopulmonary dysplasia,necrotizing enterocolitis,retinopathy of prematurity,patent ductus arteriosus,intra-ventricular hemorrhage,nose injury,pneumothorax between the two groups.Conclusion As an initial respiratory support for the treatment of low-birth-weight RDS preterm infants,HHHFNC has similar efficacy and safety with NIPPV,and further clinical research is needed.