加温加湿高流量吸氧在早产儿CPAP撤离后的应用

Application of heated humidified high-flow nasal cannula after weaning continuous positive airway pressure

目的探讨加温加湿高流量鼻导管吸氧(HHHFNC)在早产儿持续性呼气末正压通气(CPAP)撤离后应用的临床疗效。方法选择2016年1月至2017年2月期间在东南大学医学院附属江阴医院新生儿重症监护病房中孕周≤34周、出生体质量≤2 000g及日龄≤24h且准备撤离CPAP的早产儿82例为研究对象。将纳入对象随机分为治疗组(HHHFNC组)43例和对照组(鼻导管吸氧组)39例,观察患儿一次性成功撤离CPAP的比例、总呼吸支持所需时间、体质量增长速度、支气管肺发育不良(BPD)和早产儿视网膜病变(ROP)的发生率、院内感染及撤离CPAP后气漏的发生率。结果与对照组相比,治疗组一次性撤离CPAP成功率较高(χ~2=4.89,P<0.05),所需氧气治疗时间、总呼吸支持时间均低于对照组(t值分别为2.23、2.17,均P<0.05),治疗组体质量增长速度较对照组快(t=2.15,P<0.05)。两组患儿的BPD和ROP的发生率、院内感染发生率比较差异均无统计学意义(均P>0.05),两组均未发生气漏。结论与鼻导管吸氧比,HHHFNC作为CPAP撤离后的呼吸支持,患儿一次性CPAP撤离成功率高,需氧气及呼吸支持的时间短,体质量增长快。BPD及ROP发生率、气漏及院内感染的发生率均未增加。

Objective To evaluate the clinical efficacy of heated humidified high-flow nasal cannula（HHHFNC）after weaning continuous positive airway pressure（CPAP）for preterm infants.Methods Subjects were 82 preterm infants admitted to Jiangyin Hospital Affiliated to Southeast University Medical School from January 2016 to February 2017.The inclusion criteria were gestational age≤34 wk,birth weigh≤2000 g,admission within 24 hafter birth and ready to wean CPAP.The cases were randomly assigned into therapy group（HHHFNC group）and control group（nasal cannula oxygen therapy group）.Primary outcomes were observed,including rate of one-time successful weaning CPAP,duration of respiratory support,weight gain rate,incidence of broncho-pulmonary dysplasia（BPD）and retinopathy of prematurity（ROP）,nosocomial infection rate and air leak after weaning CPAP.Results Compared to the control group,one-time successful weaning CPAP was higher（χ~2=4.89,P〈0.05）,oxygen duration and respiratory support duration were lower（t value was 2.23 and 2.17,respectively,both P〈0.05）,and weight gain rate was higher（t=2.15,P〈0.05）in the therapy group.No statistical differences were observed between two groups in incidences of BPD,ROP and nosocomial infection（all P〈0.05）.No air leak was observed in both groups.Conclusion Comparing with nasal cannula oxygen therapy,HHHFNC gets higher rate of one-time successful weaning CPAP,and duration of oxygen therapy and respiratory support are shorter.Weight gain rate is higher.Incidences of BPD,ROP,air leak and nosocomial infection do not rise.