加温湿化高流量鼻导管吸氧在早产儿呼吸窘迫综合征治疗中的临床研究

Effect of heated humidified high flow nasal cannula in treatment for neonatal respiratory distress syndrome

目的探究加温湿化高流量鼻导管吸氧(HHHFNC)在早产儿呼吸窘迫综合征(RDS)初始治疗中应用的效果及安全性。方法选取2018年12月至2020年5月泰安市中心医院新生儿重症监护室(NICU)收治并符合纳入标准的临床诊断为RDS的早产儿129例。根据随机数字表法随机分为实验组与对照组,实验组给予HHHFNC辅助呼吸,对照组给予经鼻持续正压通气(NCPAP)辅助呼吸。治疗过程中根据患儿胸片检查情况及患儿吸入气体氧浓度分数(FiO_(2)),将患儿分为两组。A组:胸片提示RDS Ⅰ~Ⅲ级且FiO_(2)≤0.4(轻中度组),B组:胸片提示RDS Ⅳ级或FiO_(2)>0.4(重度组)。比较两大组中各自的实验组与对照组患儿治疗效果及并发症发生率等方面的差异。结果共分析数据125例。A组(HHHFNC组42例,NCPAP组39例),HHHFNC组在鼻损伤发生率上较NCPAP组低(2.38%vs.20.51%,P=0.009),HHHFNC组在腹胀发生率上较NCPAP组低(4.76%vs.20.51%,P=0.031),两组在其他各项指标上差异均无统计学意义(P>0.05)。B组(HHHFNC组20例,NCPAP组24例),治疗效果上HHHFNC组患儿气管插管发生率较NCPAP组高(40.00%vs.12.50%,P=0.036),HHHFNC组患儿无创通气时间较NCPAP组患儿高(t=2.219,P=0.032),住院时间上HHHFNC组较NCPAP组高(Z=-2.414,P=0.016);并发症上HHHFNC组患儿鼻损伤发生0例,NCPAP组患儿鼻损伤发生6例,发生率为25.00%,P=0.025差异有统计学意义;两组在其他各项指标上差异均无统计学意义(P>0.05)。结论HHHFNC可作为轻中度早产儿RDS初始治疗的一线治疗方案,但对于重度RDS早产儿,HHHFNC作为初始治疗方案时,选择应慎重。

【Objective】To investigate the effect and safety of heated humidified high flow nasal cannula(HHFNC)in the initial treatment of neonatal respiratory distress syndrome(RDS).【Methods】One hundred and twenty-nine infants who meet the inclusion criteria and were diagnosed with neonatal respiratory distress syndrome spelling to our neonatal intensive care unit(NICU)from Dec.2018 to May.2020 were recruited.They were randomly assigned to HHHFNC group and nasal continuous positive airway pressure(NCPAP)group.Then they were assigned to A group and B group during the healing process according to their Xray chest films and fraction of inspired oxygen(FiO2).A group:the X-ray chest films showed grade Ⅰ-Ⅲ RDS and FiO_(2)≤0.4.B group:X-ray chest films showed grade Ⅳ RDS or FiO_(2)>0.4.The therapeutic effect and complication ratio were compared between two groups.【Results】The clinical data of 125 infants were analyzed.A group(42 infants of HHHFNC group and 39 infants of NCPAP group):the incidence of nasal damage(2.38%vs.20.51%,P=0.009)was significantly lower in the HHHFNC group than in the NCPAP group,the incidence of abdominal distention(4.76%vs.20.51%,P=0.031)was significantly lower in the HHHFNC group than in the NCPAP group,and there were no differences in the other respiratory and clinical outcomes between the two groups(P>0.05).B group(20 infants of HHHFNC group and 24 infants of NCPAP group):there was 8 cases had the intubation again in HHHFNC group,and 3 cases in NCPAP group;the incidence of reintubation(40.00%vs.12.50%,χ^(2)=4.400,P=0.036)was lower in the HHHFNC group than in the NCPAP group;the babies of HHHFNC group had long times of noninvasive ventilation than those of NCPAP group(t test shows P=0.032);the babies of HHHFNC group had long times of hospital stays than those of NCPAP group(Mann-Whitney U test shows P=0.016);there was 0 case had nasal damage in HHHFNC group,6 cases in NCPAP group,and the incidence of nasal damage(give Fisher test,P=0.025)was significantly lower in the HHHFNC group than in the NCPAP group;there were no differences in the other respiratory and clinical outcomes between the two groups(P>0.05).【Conclusion】HHHFNC has the same effect as NCPAP in the initial treatment of mild-to-moderate neonatal RDS.But for severe neonatal RDS,HHHFNC should be carefully selected as the initial treatment.