无创高频振荡通气治疗早产儿呼吸窘迫综合征的效果观察

Observation on the efficacy of non-invasive high-frequency oscillatory ventilation for respiratory distress syndrome in premature infants

目的 比较经鼻无创高频振荡通气(NHFOV)和经鼻持续气道正压通气(NCPAP)在早产儿呼吸窘迫综合征中的临床应用效果。方法 选取2020年1月至2021年6月大理大学第一附属医院住院的56例2~3级呼吸窘迫综合征早产儿,采用随机数表法分为NHFOV组和NCPAP组,观察两组早产儿无创通气治疗前后血气指标的变化、无创通气治疗成功率、无创呼吸支持时间、并发症发生率及临床预后等指标。结果 两组患儿无创通气前血气指标比较,差异无统计学意义(P> 0.05),给予无创通气12、24 h后NHFOV组的二氧化碳分压(PaCO_(2))小于NCPAP组,而氧分压(PaO_(2))、氧合指数(OI)均大于NCPAP组,差异均有统计学意义(P <0.05);两组动脉血pH值比较,差异无统计学意义(P> 0.05)。NHFOV组无创通气治疗成功率(92.86%)高于NCPAP组(53.57%),差异有统计学意义(P <0.05),但两组无创呼吸机使用时间、无创呼吸支持时间、总用氧时间比较,差异均无统计学意义(P> 0.05)。NHFOV组的呼吸暂停发生率小于NCPAP组,差异有统计学意义(P <0.05);两组患儿治疗期间肺气漏、新生儿坏死性小肠结肠炎、支气管肺发育不良以及眼底视网膜病变发生率比较,差异均无统计学意义(P> 0.05)。结论 NHFOV作为2~3级呼吸窘迫综合征早产儿初始无创通气模式,能有效降低PaCO_(2)并提高PaO_(2),减少呼吸暂停,并发症未见增加,是一种安全有效的无创通气模式。

Objective To compare the clinical application effects of nasal non-invasive high-frequency oscillatory ventilation(NHFOV) and nasal continuous positive airway pressure(NCPAP) in premature infants with neonatal respiratory distress syndrome. Methods A total of 56 premature infants with grade 2-3 respiratory distress syndrome admitted to the First Affiliated Hospital of Dali University from January 2020 to June 2021 were selected and divided into the NHFOV group and the NCPAP group by the random number table method. The changes of blood gas indexes before and after non-invasive ventilation treatment, the success rate of non-invasive ventilation treatment,the duration of non-invasive respiratory support, the incidence of complications and the clinical prognosis were observed in the two groups of premature infants. Results There were no statistically significant differences in blood gas indexes between the two groups before non-invasive ventilation(P > 0.05). The partial pressure of carbon dioxide(PaCO_(2)) in the NHFOV group was lower than that in the NCPAP group, and 12 hours and 24 hours after non-invasive mechanical ventilation, while the partial pressure of oxygen(PaO_(2)) and oxygenation index(OI) values were higher than those in the NCPAP group, with statistically significant differences(P < 0.05), and there was no statistically significant difference in arterial blood gas pH between the two groups(P > 0.05). The success rate of non-invasive ventilation treatment in the NHFOV group(92.86%) was higher than that in the NCPAP group(53.57%), with statistically significant difference(P < 0.05), but there were no statistically significant differences in the duration of non-invasive respiratory support,non-invasive respiratory support time and the total oxygen use duration between the two groups(P > 0.05). The incidence of apnea in the NHFOV group was lower than that in the NCPAP group, and the difference was statistically significant(P < 0.05). There were no statistically significant differences in the incidences of pulmonary air leak, necrotizing enterocolitis, bronchopulmonary dysplasia and fundus retinopathy between the two groups during treatment(P > 0.05).Conclusion As an initial non-invasive ventilation mode for premature infants with grade 2-3 neonatal respiratory distress syndrome, NHFOV can effectively decrease PaCO_(2), increase PaO_(2), and reduce apnea without increase in complications. It is a safe and effective non-invasive ventilation mode.