加温加湿高流量鼻导管呼吸支持与鼻塞式持续气道正压通气在早产儿呼吸暂停治疗中的临床效果比较

Clinical effect comparison of the heated and humidified high-flow nasal catheter respiratory support and nasal congestion continuous positive airway pressure in the treatment of premature infants with apnea

目的比较加温加湿高流量鼻导管(HHFNC)呼吸支持与鼻塞式持续气道正压通气(NCPAP)在早产儿呼吸暂停治疗中的临床效果。方法选取2020年1月至2021年3月江阴市人民医院收治的90例呼吸暂停早产儿,使用投硬币法分为HHFNC组和NCPAP组,每组各45例。HHFNC组采用HHFNC呼吸支持治疗,NCPAP组采用NCPAP呼吸支持治疗。观察两组患儿的治疗有效率、机械通气时间、无创通气的时间、需氧时间、开奶时间、达全胃肠内喂养时间、住院时间及腹胀、鼻部损伤、支气管肺发育不良(BPD)、动脉导管未闭(PAD)发生率。结果两组患儿的治疗有效率、机械通气时间比较,差异无统计学意义(P>0.05)。HHFNC组患儿无创通气时间及需氧时间短于NCPAP组,差异有统计学意义(P<0.05);HHFNC组患儿开奶时间、达全胃肠内喂养时间早于NCPAP组,差异有统计学意义(P<0.05);HHFNC组患儿住院时间短于NCPAP组,差异有统计学意义(P<0.05)。HHFNC组患儿的腹胀及鼻损伤发生率低于NCPAP组,差异有统计学意义(P<0.05);两组患儿的BPD以及PDA发生率比较,差异无统计学意义(P>0.05)。结论HHFNC在早产儿呼吸暂停中呼吸支持效果与NCPAP无明显差异,但HHFNC能缩短无创通气时间、需氧时间及患儿住院时间,还能顺利开奶,减轻腹胀,使达全肠道喂养时间提前,同时住院时间更短,治疗费用更低。HHFNC还可以降低鼻部损伤的发生率,使患儿的舒适度明显增加。

Objective To compare the clinical effect of heated and humidified high-flow nasal catheter(HHFNC)respiratory support and nasal congestion continuous positive airway pressure(NCPAP)in the treatment of premature infants with apnea.Methods A total of 90 cases premature infants with apnea were selected treated in Jiangyin People’s Hospital from January 2020 to March 2021.They were divided into the HHFNC group and the NCPAP group by coin-toss method,45 cases in each group.The HHFNC group was treated with HHFNC respiratory support.The NCPAP group was treated with NCPAP respiratory support.The effective rate of treatment,mechanical ventilation time,non-invasive ventilation time,aerobic time,feeding time,total gastrointestinal feeding time,hospitalization time,and the incidence of abdominal distension,nasal injury,bronchopulmonary dysplasia(BPD)and patent ductus arteriosus(PAD)in the two groups were observed.Results There were no significant differences in the treatment efficiency and mechanical ventilation time between the two groups(P>0.05).The non-invasive ventilation time and aerobic time in the HHFNC group were shorter than those in the NCPAP group,and the differences were statistically significant(P<0.05).The feeding time and total gastrointestinal feeding time in the HHFNC group were earlier than those in the NCPAP group,the differences were statistically significant(P<0.05).The hospitalization time in the HHFNC group was shorter than that in the NCPAP group,and the difference was statistically significant(P<0.05).The incidence of abdominal distension and nasal injury in the HHFNC group was lower than that in the NCPAP group,and the difference was statistically significant(P<0.05).There was no significant difference in the incidence of BPD and PDA between the two groups(P>0.05).Conclusion There is no significant difference between HHFNC and NCPAP in respiratory support in preterm infants with apnea.However,HHFNC can reduce the time of non-invasive ventilation,oxygen use and hospital stay of the child.It can also smoothly start milk,reduce abdominal distension,and achieve full intestinal feeding.The time is earlier,while the hospital stay is less,and the treatment cost is lower.HHFNC can also reduce the incidence of nasal injuries and significantly increase the comf ort of children.