经鼻无创高频振荡通气在治疗婴幼儿重症肺炎方面的临床应用

Clinical Application of Noninvasive High Frequency Concussion Ventilation in the Treatment of Infant Pneumonia

目的通过经鼻无创高频振荡通气(Nasal non-invasive high frequency oscillatory ventilation,n HFOV)与经鼻持续气道正压通气(nasal continuous positive airway pressure n CPAP)这两种通气模式在婴幼儿重症肺炎中的无创辅助通气,探究初始治疗中的临床效果及并发症的发生。方法选取2020.06至2022.06在新生儿重症监护病房(neonatal intensive care unit,NICU)住院的合并呼吸衰竭的婴幼儿肺炎(14d-3m)57例,随机分为观察组(n HFOV组)(27例)及对照组(n CPAP组)(30例);比较两组患儿在无创呼吸机治疗4-6小时后的相关血气分析数据变化,治疗的成功率,上机时间,二氧化碳变化率及各种不良反应的发生率。结果n HFOV组和n CPAP组相比,n HFOV组初始治疗的成功率,呼吸机应用时间,喂养不耐受及心动过速发生率,治疗6小时后PCO_(2)变化率,经统计学分析,均有明显差异,(P<0.05)差异有统计学意义;在鼻中隔损伤、消化道出血等并发症的发生率方面,经统计学分析,差异无统计学意义。结论n HFOV作为婴幼儿重症肺炎的初始无创通气模式,n HFOV临床应用效果明显优于n CPAP,在喂养不耐受及心动过速等并发症发生率方面有明显的差异,可以作为一种创伤性小的无创通气模式,应用于婴幼儿重症肺炎的治疗中,从而最大限度地避免了有创机械通气的应用,减少相关并发症的发生。

Objective To explore the therapeutic effect and occurrence of complications of the initial noninvasive high frequency oscillatory ventilation(nHFOV)and nasal continuous positive airway pressure(nCPAP)on the initial treatment of infant severe pneumonia.Method A total of 57cases with severe infant were randomly assigned into nHFOV group(n=27)and nCPAP group(n=30).The changes of blood gas analysis data after 4-6 hours of noninvasive ventilator treatment,Success rate of initial treatment,The machine treatment time,The rate of change of the partial pressure of carbon dioxide and the incidences of various adverse reactions were compared between the observation group and the control group.Results NHFOV group Compared with nCPAP group,nHFOV group had significantly higher the success rate of removing the ventilator,higher rate of change in carbon dioxide at 6hours after treatment,shorter duration of ventilator use,lower rates of feeding intolerance and tachycardia,In the nasal septum injury,gastrointestinal bleeding and other complications,There was no significant difference in the incidence of complications.Conclusion As the initial non-invasive ventilation mode for infantile pneumonia,The clinical effect of nHFOV is better than nCPAP,There are significant differences in the incidence of complications such as feeding intolerance and tachycardia,nHFOV can be used as a less traumatic non-invasive ventilation mode in the treatment of infant pneumonia.Thus,the application of invasive mechanical ventilation can be avoided to the maximum extent and the incidence of related complications can be reduced.