加温湿化高流量鼻导管氧疗在1～3月龄肺炎伴低氧血症患儿中的应用

Application of Heated Humidified High Flow Nasal Cannula Oxygen Therapy in the Treatment of Pneumonia with Hypoxemia for Infants from 1 to 3 Months

目的:观察加温湿化高流量鼻导管氧疗(HFNC)对1~3月龄肺炎伴低氧血症患儿的临床疗效。方法:分析2016年10月至2017年9月我院PICU收治、未达到机械通气指征的1~3月龄伴有低氧血症的肺炎患儿,采用随机数表法分为HFNC治疗组、经鼻持续气道正压通气(n CPAP)治疗组和普通鼻导管吸氧治疗组(对照组),给予相应治疗。比较三组临床疗效,治疗前和治疗后1 h、12 h、24 h的PaO2、P/F、呼吸频率等指标,患儿主要症状体征消失时间和住院时间,气漏发生情况。结果:与对照组比较,HFNC组和n CPAP组有效率明显增加(46. 7%vs 90. 0%、86. 7%,P<0. 05),但HFNC组与n CPAP组比较差异无统计学意义(P>0. 05);HFNC组和n CPAP组患儿治疗过程中出现气漏例数明显减少(P<0. 05)。HFNC组和n CPAP组治疗后患儿的三凹征、呼吸急促、肺部啰音消失时间及平均住院时间与对照组比较明显缩短(P<0. 05),但HFNC组和n CPAP组比较差异无统计学意义(P>0. 05);与对照组比较,HFNC组与n CPAP组在治疗后1 h、12 h、24 h PaO2、P/F升高,呼吸频率减慢(P<0. 05),但HFNC组和n CPAP组比较差异无统计学意义(P> 0. 05)。结论:HFNC治疗1~3月龄伴有低氧血症的肺炎患儿疗效显著,损伤小,是一种适宜1~3月龄婴儿的无创呼吸支持技术。

Objective:To observe the clinical efficacy of heated humidified high flow nasal cannula oxygen therapy(HFNC)in the treatment of pneumonia with hypoxemia for infants from 1 to 3 months.Methods:Children with pneumonia and hypoxemia aged from 1 to3 months who were admitted into PICU of our hospital from Oct.2016 to Sept.2017 and did not meet the mechanical ventilation indication were extracted.All children were divided into HFNC treatment group,nasal continuous positive airway pressure(n CPAP)treatment group and normal nasal catheter oxygen treatment group(control group)by the random number table method,and appropriate treatment was given.The clinical efficacy,PaO2,P/F,respiratory rate and other indicators before treatment and after treatment of 1 h,12 h and 24 h,disappearance time of main symptoms and signs,length of stay and occurrence of air leak were compared among three groups.Results:Compared with the control group,the effective rate of HFNC group and n CPAP group increased significantly(46.7%vs 90.0%,86.7%,P<0.05),but there was no significant difference between the HFNC group and the n CPAP group(P>0.05).The number of cases of air leak in the HFNC group and n CPAP group significantly reduced during the treatment(P<0.05).The disappearance time of three concave sign,shortness of breath and lung rales,and the average length of stay in the HFNC group and the n CPAP group were significantly shorter than those in the control group(P<0.05),but there was no significant difference between the HFNC group and the n CPAP group(P>0.05).Compared with the control group,PaO2 and P/F increased and respiratory rate decreased after treatment of 1 h,12 h,and 24 h in the HFNC group and the n CPAP group(P<0.05),but there was no significant difference between the HFNC group and the n CPAP group(P>0.05).Conclusion:The efficacy of HFNC in the treatment of pneumonia with hypoxemia for infants from 1 to 3 months is significant with minimal damage.It is a non-invasive respiratory support technology and suitable for infants from 1 to 3 months.