NHFOV治疗早产儿RDS的临床研究

Clinical analysis of noninvasive high-frequency oscillatory ventilation in the treatment of preterm infants with respiratory distress syndrome

目的评估无创高频振荡通气(NHFOV)治疗早产儿呼吸窘迫综合征(RDS)的疗效及安全性,以及对患儿肺表面活性物质D(SP-D)和肺组织水通道蛋白5(AQP-5)水平的影响。方法选择2017年1月至2019年3月在西电集团医院新生儿科诊治的RDS早产患儿174例,按随机数字表法分为NHFOV组和经鼻持续气道正压通气(NCPAP)组各87例,两组基础治疗相同。比较两组的临床治疗有效率、有创通气持续时间、无创通气持续时间、第二剂肺表面活性剂(PS)使用率、治疗前后动脉血气变化及血清SP-D和AQP-5水平等。结果NHFOV组的临床治疗有效率(94.3%)显著高于NCPAP组(82.8%)(χ2=5.23,P<0.05),NHFOV组的第二剂PS使用率显著低于NCPAP组(χ2=6.83,P<0.05),NHFOV组的无创通气时间显著低于NCPAP组(t=13.01,P<0.05)。两组患儿的动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2)、动脉血氧分压与吸入氧分数比(PaO2/FiO2)、呼吸指数(RI)、酸碱度(pH)在治疗后均较治疗前显著改善,差异均有统计学意义(NCPAP组F值分别为4.78、7.92、8.72、7.86、6.23,均P<0.05;NHFOV组F值分别为4.05、8.63、8.78、9.92、5.89,均P<0.05)。NHFOV组的血气指标在治疗后12、24、48、72h各时间点均显著优于NCPAP组,差异均有统计学意义(PaO2:t值分别为5.21、6.52、4.87、7.35,均P<0.05;PaCO2:t值分别为6.21、5.09、4.83、7.98,均P<0.05;PaO2/FiO2:t值分别为5.85、7.68、6.32、6.93,均P<0.05;RI:t值分别为6.33、7.25、8.07、6.94,均P<0.05;pH:t值分别为5.58、4.98、6.37、5.78,均P<0.05)。在治疗初12h内,两组的SP-D、AQP-5水平无显著性差异(均P>0.05),治疗后12、24、48、72h各时间点NHFOV组血清SP-D、AQP-5水平均显著低于NCPAP组,差异均有统计学意义(SP-D:t值分别为6.23、7.15、5.92、6.89,均P<0.05;AQP-5:t值分别为4.53、5.38、6.59、7.32,均P<0.05)。结论NHFOV治疗早产儿RDS疗效较好,且不增加并发症风险,可有效改善氧合,促进通气,降低其肺损伤风险。

Objective To investigate the clinical efficacy and safety of noninvasive high-frequency oscillatory ventilation(NHFOV)in the treatment of premature infants with respiratory distress syndrome(RDS)and the influence on the serum level of pulmonary surfactant D(SP-D)and lung tissue water channel protein 5(AQP-5)in preterm infants.Methods 174 preterm infants with RDS treated in the neonatology department of China Xidian Group Hospital from January 2017 to May 2019 were selected,and randomly divided into the NHFOV group(87 cases)and the nasal continue positive airway pressure(NCPAP)group(87 cases)according to the random number table methods.Basic treatment was the same in both groups.Some index or parameters were observed and compared between the two groups,such as clinical treatment efficiency,duration of invasive ventilation and noninvasive ventilation,utilization rate of the second dose of pulmonary surfactant(PS),arterial blood gas changes and serum SP-D and AQP-5 levels before and after treatment.Results The clinical response rate of the NHFOV group was significantly higher than that of the NCPAP group(92.3%vs.82.7%,χ2=5.23,P<0.05).The second PS utilization rate(χ2=6.83,P<0.05)and noninvasive ventilation duration(t=13.01,P<0.05)in NHFOV group were significantly lower than that in the NCPAP group.The partial pressure of oxygen in arterial blood(PaO2),partial pressure of carbon dioxide in arterial blood(PaCO2),ratio of oxygen partial pressure in arterial blood to fraction inhaled oxygen(PaO2/FiO2),respiratory index(RI)and pH value in the two groups were significantly improved after treatment,and the differences were statistically significant(NCPAP group:F=4.78,7.92,8.72,7.86 and 6.23,respectively,all P<0.05.NHFOV group:F=4.05,8.63,8.78,9.92 and 5.89,respectively,all P<0.05).The blood gas index in the NHFOV group were significantly better than those in the NCPAP group at 12,24,48 and 72 hours after therapy,and the differences were statistically significant(PaO2:t=5.21,6.52,4.87 and 7.35,respectively,all P<0.05;PaCO2:t=6.21,5.09,4.83 and 7.98,respectively,all P<0.05;PaO2/FiO2:t=5.85,7.68,6.32 and 6.93,respectively,all P<0.05;RI:t=6.33,7.25,8.07 and 6.94,respectively,all P<0.05;pH:t=5.58,4.98,6.37 and 5.78,respectively,all P<0.05).There was no significant difference in the levels of SP-D and AQP-5 between the two groups in 12 hours after treatment(both P>0.05),but the levels of SP-D(t=6.23,7.15,5.92 and 6.89,respectively,all P<0.05)and AQP-5(t=4.53,5.38,6.59 and 7.32,respectively,all P<0.05)after 12 hours in the NHFOV group were significantly lower than those in the NCPAP group.Conclusion It is observed to be better efficacy and safety of NHFOV in RDS treatment with no increased complication risk in preterm infants,which can be attributable to improved oxygenation and ventilation effectively,decreased risk of lung injury as well as.