加温湿化高流量鼻导管通气用于预防新生儿呼吸窘迫综合征拔管失败的效果

Heated Humidified High-Flow Nasal Cannula for Preventing Extubation Failure in Neonatal Respiratory Distress Syndrome

目的探讨加温湿化高流量鼻导管通气(HHHFNC)用于预防新生儿呼吸窘迫综合征(NRDS)拔管失败的临床效果。方法 将108例NRDS患儿按随机数字表法分为对照组和试验组,每组54例。对照组采用经鼻持续气道正压通气(NCPAP)治疗,试验组采用HHHFNC治疗。观察2组用氧时间和有创、无创通气时间及并发症(包括腹胀、肺气漏、感染、鼻内损伤等)发生率、拔管失败率。结果 2组无创通气时间比较差异无统计学意义( P > 0.05 ),2组拔管失败率比较差异无统计学意义(11.11%比16.67%, P >0.05)。试验组用氧时间、有创通气时间均较对照组显著缩短[(18.45±5.43)d、(6.32±2.98)d比(23.17±5.87)d、(8.44±3.36)d,均 P <0.05)];试验组腹胀、肺气漏、感染、鼻内损伤发生率分别为7.41%、1.85%、1.85%、12.96%,均显著低于对照组的27.78%、12.96%、 12.96%、37.04%( P <0.05)。结论 HHHFNC用于预防新生儿呼吸窘迫综合征拔管失败的效果与NCPAP相当,但HHHFNC在缩短用氧和有创通气时间、减少并发症的发生等方面具有一定的优势。

Objective To explore the clinical efficacy of heated humidified high-flow nasal cannula(HHHFNC) for preventing extubation failure in neonatal respiratory distress syndrome(NRDS). Methods A total of 108 children with NRDS were randomly treated with either nasal continuous positive airway pressure(NCPAP)(control group, n =54) or HHHFNC(experimental group, n =54).Oxygen consumption time,invasive ventilation time,non-invasive ventilation time,incidence of complications(abdominal distention,pulmonary air leak,infection,nasal injury,etc.) and rate of extubation failure were observed in both groups. Results There was no significant difference between the two groups in non-invasive ventilation time( P >0.05),as well as in extubation failure rate(11.11% vs 16.67%, P >0.05).The oxygen consumption time and invasive ventilation time in experimental group((18.45±5.43) days and(6.32±2.98) days,respectively) were shorter than those in control group((23.17±5.87) days and(8.44±3.36) days,respectively)( P <0.05).The incidences of abdominal distention,pulmonary air leak,infection and nasal injury in experimental group(7.41%,1.85%,1.85% and 12.96%,respectively) were lower than those in control group(27.78%,12.96%,12.96% and 37.04%,respectively)( P <0.05). Conclusion The HHHFNC is comparable to NCPAP for preventing extubation failure in NRDS.However,HHHFNC is superior to NCPAP for shortening oxygen consumption and invasive ventilation time and reducing complications.