经鼻持续气道正压通气与经鼻无创高频振荡通气在新生儿胎粪吸入综合征机械通气撤机中的应用

Application of nasal continuous positive airway pressure ventilation and nasal non-invasive high-frequency oscillatory ventilation in mechanical ventilation weaning of neonatal meconium aspiration syndrome

目的探究经鼻持续气道正压通气(NCPAP)与经鼻无创高频振荡通气(NHFOV)在新生儿胎粪吸入综合征(MAS)机械通气撤机中的应用。方法选取安徽省阜阳市妇女儿童医院新生儿科于2019年5月至2022年5月收治的80例新生儿MAS患儿为研究对象,采取抽签法分为NCPAP组、NHFOV组,各40例。两组MAS患儿机械通气撤机后分别行NCPAP、NHFOV呼吸支持。比较两组撤机前和撤机后1、12、24 h血气指标[动脉血氧分压(PaO_(2))、动脉血二氧化碳分压(PaCO_(2))、PaO_(2)/吸入氧浓度(FiO_(2))];比较两组无创呼吸时间、全胃肠营养时间、撤机失败率及并发症发生情况。结果两组PaO_(2)、PaO_(2)/FiO_(2)时间比较,差异有统计学意义(P<0.01);两组PaCO_(2)时间、组间、交互作用比较,差异有统计学意义(P<0.01)。组内比较:撤机后1、24 h,两组PaO_(2)高于撤机前;撤机后24 h,两组PaO_(2)/FiO_(2)高于撤机前,差异有统计学意义(P<0.05)。撤机后12、24 h,NCPAP组PaCO_(2)低于撤机前;撤机后1、12、24 h,NHFOV组PaCO_(2)高于撤机前,差异有统计学意义(P<0.05)。组间比较:撤机后1、12、24 h,两组PaO_(2)、PaO_(2)/FiO_(2)比较,差异无统计学意义(P>0.05);NHFOV组PaCO_(2)低于NCPAP组,差异有统计学意义(P<0.05)。NHFOV组撤机失败率低于NCPAP组,差异有统计学意义(P<0.05);两组无创呼吸时间和全胃肠营养时间比较,差异无统计学意义(P>0.05)。NHFOV组并发症总发生率低于NCPAP组,差异有统计学意义(P<0.05)。结论与NCPAP比较,NHFOV应用于新生儿MAS患儿机械通气撤机中更有利于降低患儿PaCO_(2),降低撤机失败率。

Objective To explore the application of nasal continuous positive airway pressure(NCPAP)and nasal non-invasive high-frequency oscillatory ventilation(NHFOV)in mechanical ventilation weaning of neonatal meconium aspiration syndrome(MAS).Methods A total of 80 newborns with MAS admitted to the Department of Neonatology,Fuyang Women’s and Children’s Hospital,Anhui Province from May 2019 to May 2022 were selected as the research objects.They were divided into NCPAP group and NHFOV group,with 40 cases in each group.MAS children of two groups were respectively given NCPAP and NHFOV respiratory support after mechanical ventilation weaning.The blood gas index(partial pressure of oxygen in arterial blood[PaO_(2)],partial pressure of carbon dioxide in arterial blood[PaCO_(2)],PaO_(2)/inspired oxygen concentration[FiO_(2)])were compared between two groups before weaning and after weaning at 1,12,24 h;non-invasive breathing time,total gastrointestinal nutrition time,weaning failure rate,and complications were compared between two groups.Results PaO_(2),PaO_(2)/FiO_(2) at different time between two groups were statistically significant(P<0.01);PaCO_(2) at different time,intergroup,and interaction between two groups were statistically significant(P<0.01).Comparison within groups:after weaning at 1,24 h,PaO_(2) in both groups were higher than those before weaning;after weaning at 24 h,PaO_(2)/FiO_(2) in two groups were higher than those before weaning,and the differences were statistically significant(P<0.05).After weaning at 12,24 h,PaCO_(2) of NCPAP group were lower than those before weaning;after weaning at 1,12,24 h,PaCO_(2) of NHFOV group were higher than those before weaning,and the differences were statistically significant(P<0.05).Comparison among groups:after weaning at 1,12,24 h,there were no significant differences in PaO_(2) and PaO_(2)/FiO_(2) between two groups(P>0.05);PaCO_(2) in NHFOV group was lower than that in NCPAP group,and the difference was statistically significant(P<0.05).The weaning failure rate of NHFOV group was lower than that of NCPAP group,and the difference was statistically significant(P<0.05);there were no significant differences in non-invasive breathing time and total gastrointestinal nutrition time between two groups(P>0.05).The total complication rate of NHFOV group was lower than that of NCPAP group,and the difference was statistically significant(P<0.05).Conclusion Compared with NCPAP,the application of NHFOV in mechanical ventilation weaning of neonatal MAS children is more conducive to reducing PaCO_(2) and reducing the weaning failure rate.