加热、湿化经鼻高流量氧疗联合肺表面活性物质对新生儿呼吸窘迫综合征的疗效观察

Observation of curative effect of HHFNC on neonatal respiratory distress syndrome

目的观察加热、湿化经鼻高流量氧疗(HHFNC)联合肺表面活性物质对新生儿呼吸窘迫综合征(RDS)的治疗作用。方法选取2017年1月至2018年4月我院治疗的124例RDS新生儿。使用随机数字法分为对照组和观察组,每组各62例。对照组:鼻塞式持续气道正压通气(nCPAP)+肺表面活性物质固尔苏,观察组:HHFNC+肺表面活性物质固尔苏。比较两组疗效和并发症。结果两组治疗前氧合指数、PaO_2、PaCO_2差异无统计学意义(P>0.05),治疗24h后观察组氧合指数和PaO_2为352.34±45.17和86.52±11.43mmHg,显著高于对照组的312.08±41.34和77.48±9.62mmHg(P<0.05),观察组PaCO_2为30.87±4.36mmHg,显著低于对照组的41.27±5.63mmHg(P<0.05)。观察组总有效率为88.7%(55/62),显著高于对照组的72.6%(45/62)(P<0.05)。观察组无创通气时间为83.15±10.34 h,显著短于对照组的98.46±12.17 h(P<0.05)。观察组改为有创机械通气率为6.5%(4/62),显著低于对照组的16.1%(10/62)(P<0.05),观察组治疗后支气管肺发育不良发生率为11.3%(7/62),显著低于对照组的24.2%(15/62)(P<0.05)。观察组鼻部损伤和腹胀发生率为3.2%(2/62)和8.1%(5/62),显著低于对照组的17.7%(11/62)和19.4%(12/62)(P<0.05)。结论 HHFNC治疗新生儿RDS疗效显著,使用安全,可显著降低支气管肺发育不良的发生率。

Objective To detect the curative effect of HHFNC on neonatal respiratory distress syndrome (RDS). Methods 124 neonatal RDS were enrolled in this study and were divided into the control group ( n =42) and the observation group ( n =42). The control group was given nCPAP+ Curosurf, and the observation group was given HHFNC+ Curosurf. The curative effect and complications were compared between the two groups. Results There was no significant difference in oxygenation index, PaO 2 and PaCO 2 between the two groups before treatment ( P> 0.05). 24h after treatment, the value of oxygenation index and PaO 2 in the observation group was 352.34±45.17 and 86.52±11.43mmHg, which was significantly higher than 312.08±41.34 and 77.48±9.62mmHg in the control group ( P< 0.05). The value of PaCO 2 was 30.87±4.36mmHg in the observation group, which was lower than 41.27±5.63mmHg in the control group ( P< 0.05). The effective rate in the observation group was 88.7%(55/62), which was significantly higher than 72.6%(45/62) in the control group ( P< 0.05). The time of auxiliary mechanical ventilation in the observation group was 83.15±10.34 h, which was significantly shorter than 98.46±12.17 d in the control group ( P< 0.05). The change to the invasive mechanical ventilation in the observation group was 6.5%(4/62), which was significantly lower than 16.1%(10/62) in the control group ( P< 0.05). The incidence of bronchopulmonary dysplasia in the observation group was 11.3%(7/62), which was significantly lower than 24.2%(15/62) in the control group ( P< 0.05). Conclusion HHFNC is effective and safe in treatment of neonatal RDS, and it can significantly reduce the incidence of bronchopulmonary dysplasia.