经鼻无创高频振荡通气与持续气道正压通气在早产儿呼吸窘迫综合征初始治疗中的效果比较

Nasal high-frequency oscillatory ventilation versus nasal continuous positive airway pressure in preterm infants with respiratory distress syndrome

目的比较早期应用无创高频振荡通气(nasal high frequency oscillatory ventilation,nHFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)作为早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)初始治疗的临床效果。方法选取在新生儿重症监护病房(neonatal intensive care unit,NICU)住院治疗的86例RDS早产患儿,随机分为nHFOV组(n=44)及nCPAP组(n=42)。分析比较两组患儿初始治疗失败率、呼吸支持治疗相关数据、病死率及各种不良反应发生的情况。结果nHFOV组初始治疗失败率、BPD发生率、总通气时间、治疗后二氧化碳分压(partial pressure of carbon dioxide,PaCO2)均明显低于nCPAP组,差异有统计学意义(P<0.05);而两组治疗后氧分压(partial pressure of oxygen,PaO2)、病死率、无创通气时间以及新生儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)、早产儿视网膜病(retinopathy of prematurity,ROP)、颅内出血(intraventricular hemorrhage,IVH)、消化道穿孔、气胸/气漏及鼻损伤等不良反应发生率差异无统计学意义(P>0.05)。结论作为RDS早产儿的初始治疗方式,nHFOV临床治疗效果优于nCPAP,而各种不良反应发生率较nCPAP低或相当,可作为一种新的无创通气方式在临床使用。

Objective To compare the efficacy of nasal high-frequency oscillatory ventilation(nHFOV)with nasal continuous positive airway pressure(nCPAP)in preterm infants with respiratory distress syndrome(RDS).Methods Eighty-six premature infants with RDS were randomly assigned into nHFOV group and nCPAP group.The incidence of initial treatment failure,the parameters of blood-gas test and the incidence of complications were analyzed.Results The need for intubation and mechanical ventilation within 7 days,the incidence of bronchopulmonary dysplasia(BPD)and days receiving ventilation were significantly lower in the nHFOV group compared with the nCPAP group(11.4%vs.31.0%,4.5%vs.19.0%,4.0 days vs.5.0 days,P<0.05).The partial pressure of carbon dioxide(PaCO2)was significantly in nHFOV group than that of nCPAP group after treatment(38.3±7.2 mmHg vs.44.4±9.8 mmHg,P<0.05).There was no significant difference in the mortality,the time of noninvasive mechanical ventilation,or the incidences of nose injury and pneumothorax between the two groups(P>0.05).Conclusion In this prospective,randomized controlled study,nHFOV significantly reduces the need for invasive mechanical ventilation and the incidence of BPD compared with nCPAP in preterm infants with RDS,without increase in adverse effects.