早产儿肺出血拔管后序贯加温、加湿高流量鼻导管吸氧的疗效

Efficacy of sequential heated humidified high flow nasal cannula after extubation in premature infants with pulmonary hemorrhage

目的探讨早产儿肺出血拔管后序贯加温、加湿高流量鼻导管吸氧(HHHFNC)的临床疗效。方法回顾性选取2017年1月至2018年1月南京医科大学附属苏州医院收治的早产肺出血患儿52例,按随机数字表法分为2组,拔管后分别予HHHFNC(HHHFNC组,25例)及经鼻间歇正压通气(NIPPV组,27例)进行序贯治疗。首先对2组患儿基本情况[出生胎龄、出生体质量、发生肺出血后机械通气天数、高频通气、一氧化氮(NO)使用]、拔管前血气分析指标及呼吸机参数指标包括拔管前1h动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、pH值、呼气末正压(PEEP)、呼吸频率(RR)、吸气峰压(PIP)、吸入氧体积分数(FiO2)进行比较分析;对比分析HHHFNC组及NIPPV组拔管后血气分析指标[拔管后1hpa(O2)、pa(CO2)、pH值]、治疗结束时终点事件/并发症(再插管、肺出血后总吸氧时间、住院天数、支气管肺发育不良、呼吸机相关性肺炎、喂养不耐受、新生儿坏死性小肠结肠炎、气胸)。结果NIPPV组和HHHFNC组患儿出生胎龄[(30.5±2.9)周比(31.6±2.7)周]、出生体质量[1325(818)g比1400(800)g]、发生肺出血后机械通气时间(5d比4d)、高频通气率[25.9%(7/27例)比24.0%(6/25例)]、NO使用率[7.4%(2/27例)比0(0/25例)]差异均无统计学意义(均P>0.05);拔管前后血气分析指标及呼吸机参数指标组间比较差异均无统计学意义(均P>0.05);NIPPV组和HHHFNC组患儿再插管率[7.4%(2/27例)比4.0%(1/25例)]、住院天数[43(29)d比41(22)d]、支气管肺发育不良发生率[40.7%(11/27例)比16.0%(4/25例)]、呼吸机相关性肺炎发生率[11.1%(3/27例)比12.0%(3/25例)]、喂养不耐受发生率[37.0%(10/27例)比32.0%(8/25例)]、新生儿坏死性小肠结肠炎发生率[7.4%(2/27例)比12.0%(3/25例)]、气胸发生率[7.4%(2/27例)比12.0%(3/25例)]比较差异均无统计学意义(均P>0.05);肺出血后总吸氧时间比较差异有统计学意义[25(30)d比9(22)d,P<0.05]。结论对于早产儿肺出血拔管后,相对于NIPPV,HHHFNC可减少患儿肺出血后总氧疗时间,是一种较为理想的序贯治疗策略。

Objective To investigate the clinical efficacy of sequential heated humidified high flow nasal ca-nnula(HHHFNC)after extubation in premature infants with pulmonary hemorrhage.Methods A total of 52 premature infants with pulmonary hemorrhage were selected,who were randomly(by means of random number table)given nasal intermittent positive pressure ventilation(NIPPV)(27 cases)and HHHFNC(25 cases)as a sequential respiratory su-pport from January 2017 to January 2018 at Suzhou Hospital of Nanjing Medical University were selected.The incidence of the basic conditions of the 2 groups of premature infants[gestational age,birth weight,mechanical ventilation days after pulmonary hemorrhage,high-frequency ventilation,usage of nitric oxide(NO)],blood gas analysis indicators at 1 h before extubation and ventilator parameters including the arterial oxygen partial pressure[pa(O2)],arterial partial pressure of carbon dioxide[pa(CO2)],pH value,positive end-expiratory pressure(PEEP),respiratory rates(RR),peak inspiratory pressure(PIP),fraction of inspiration oxygen(FiO2)were compared.The blood gas analysis after extubation[pa(O2),pa(CO2),pH value]at 1 h,outcome events/complications at the end of treatment(reintubation,uration of oxygen therapy after pulmonary hemorrhage,hospitalization days,bronchial pulmonary hypoplasia,ventilator associated pneumonia,feeding intolerance,neonatal necrotizing enterocolitis,pneumothorax)were also compared.Results There were no significant differences between the NIPPV group and the HHHFNC group in the following items:gestational age,birth weight,mechanical ventilation days after pulmonary hemorrhage,high-frequency ventilation,usage of NO[(30.5±2.9)weeks vs.(31.6±2.7)weeks,1 325(818)g vs.1 400(800)g,5 days vs.4 days,25.9%(7/27 cases)vs.24.0%(6/25 cases),7.4%(2/27 cases)vs.0(0/25 cases),all P>0.05].There were no significant differences between the two groups in blood gas analysis indicators before extubation at 1 h and ventilator parameters[pa(O2),pa(CO2),pH value,PEEP,RR,PIP,FiO2],blood gas analysis[pa(O2),pa(CO2),pH value]after extubation at 1 h(all P>0.05);There were no significant differences between the two groups in reintubation,hospitalization days,bronchial pulmonary hypoplasia,ventilator associated pneumonia,feeding intolerance,neonatal necrotizing enterocolitis,pneumothorax[7.4%(2/27 cases)vs.4.0%(1/25 cases),43(29)days vs.41(22)days,40.7%(11/27 cases)vs.16.0%(4/25 cases),11.1%(3/27 cases)vs.12.0%(3/25 cases),37.0%(10/27 cases)vs.32.0%(8/25 cases),7.4%(2/27 cases)vs.12.0%(3/25 cases),7.4%(2/27 cases)vs.12.0%(3/25 cases)](all P>0.05).The duration of oxygen therapy after pulmonary hemorrhage in the HHHFNC group was shorter than that in the NIPPV group[25(30)days vs.9(22)days,P<0.05].Conclusions As a sequential respiratory support for preterm infants with pulmonary hemorrhage,HHHFNC has shorter duration of oxygen therapy after pulmonary hemorrhage than that of NIPPV,suggesting that HHHFNC is an ideal non-invasive ventilation treatment.