经鼻无创高频振荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中的应用

The application value of transnasal non-invasive high-frequency oscillatory ventilation combined with transcutaneous carbon dioxide and transcutaneous oxygen monitoring in preterm infants with respiratory distress syndrome

目的分析经鼻无创高频震荡通气联合经皮二氧化碳分压(TcPCO_(2))和经皮氧分压(TcPO_(2))监测在早产儿呼吸窘迫综合征中的应用。方法选择2019年10月至2021年10月收治的新生儿呼吸窘迫综合征无创呼吸支持治疗的早产儿80例,采用随机数字法分为改良组(经鼻无创高频震荡通气)和对照组(经鼻持续正压通气)。每组40例。2组均联合TcPCO_(2)和TcPO_(2)监测。观察2组通气0、6、12、24 h后的pH值、TcPCO_(2)/TcPO_(2)指标、无创通气时间、治疗失败转为气管插管机械通气率、并发症发生率及病死率。结果通气0 h,2组血液pH值、TcPCO_(2)、TcPO_(2)比较差异无统计学意义(P>0.05);与对照组比较,改良组通气6、12、24 h血液pH值、TcPO_(2)均明显升高,TcPCO_(2)均明显降低(P<0.05)。与对照组比较,无创通气时间和治疗失败转为气管插管机械通气率均明显降低(P<0.05)。2组气漏、腹胀、鼻部损伤、肺出血、感染性肺炎等并发症发生率比较差异无统计学意义(P>0.05)。对照组病死率为5.00%(2/40),改良组病死率为2.50%(1/40),差异无统计学意义(P>0.05)。结论经鼻无创高频震荡通气联合TcPCO_(2)和TcPO_(2)监测在早产儿呼吸窘迫综合征中应用价值较高,可改善患儿呼吸功能,降低气管插管机械通气率,且不会增加并发症的发生。

Objective To analyze the application of transnasal non invasive high-frequency oscillatory ventilation combined with transcutaneous carbon dioxide(TcPCO_(2))and transcutaneous oxygen(TcPO_(2))monitoring in preterm infants with respiratory distress syndrome.Methods Eighty preterm infants with neonatal infant respiratory distress syndrome and treated with noninvasive respiratory support from October 2019 to October 2021 were recruited.They were randomly divided into the modified group and control group,with 40 cases per group.Patients in the modified group were managed by transnasal noninvasive high-frequency oscillatory ventilation and those in the control group were managed by transnasal continuous positive pressure ventilation.All patients were monitored by TcPCO_(2) and TcPO_(2) measurements.The pH value and TcPCO_(2)/TcPO_(2) at 0,6,12 and 24h after ventilation,duration of noninvasive ventilation,conversion rate to tracheal intubation for treatment failure,incidence of complications and mortality were compared.Results There were no significant differences in pH value,TcPCO_(2) and TcPO_(2) at 0h between groups(P>0.05).Compared with those of the control group,patients in the modified group presented significantly higher pH value and TcPO_(2) at 6,12 and 24h,and lower TcPCO_(2)(P<0.05).Compared with those of the control group,the duration of non-invasive ventilation and the conversion rate to mechanical ventilation for treatment failure were significantly lower in the modified group(P<0.05).There were no significant differences in the incidences of air leakage,abdominal distension,nasal injury,pulmonary hemorrhage,and infectious pneumonia between groups(P>0.05).There was no significant difference in the mortality between the control group and modified group(5.00%[2/40]vs 2.50%[1/40],P>0.05).Conclusion The application value of transnasal non-invasive high-frequency oscillatory ventilation combined with TcPCO_(2) and TcPO_(2) monitoring in preterm infants with respiratory distress syndrome is high.It can improve the respiratory function of the children and reduce the rate of mechanical ventilation by tracheal intubation,without increasing the occurrence of complications.