加温湿化经鼻导管高流量通气治疗轻度NRDS的疗效及并发症

Curative effect and complications of heated humidified high flow nasal cannula therapy on the treatment of mild neonatal respiratory distress syndrome

目的:观察加温湿化经鼻导管高流量通气(HHHFNC)治疗轻度新生儿呼吸窘迫综合征(NRDS)的疗效及并发症。方法:本研究为实验研究,采用非随机抽样的方法选取济宁医学院附属医院2019年1月至2022年1月收治的120例轻度NRDS患儿为研究对象,采用随机数字表法将患儿分为2组,HHHFNC组(60例)采用HHHFNC治疗,经鼻持续气道正压通气(NCPAP)组(60例)采用NCPAP治疗。收集2组患儿的一般资料(性别、胎龄、生后小时龄、出生体重和胸片分级),辅助通气治疗前和治疗24 h后的血气指标[动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(PaCO_(2))],临床指标(总住院时间、氧疗时间、总辅助通气时间、开奶时间和建立全肠道喂养时间),并发症发生情况(鼻损伤、腹胀或肺气漏)。采用《新生儿疼痛与不适量表》(EDIN量表)评价患儿的舒适度。评估辅助通气治疗(HHHFNC或NCPAP)的疗效。结果:HHHFNC组男36例,女24例,胎龄(28.46±1.12)周;NCPAP组男34例,女26例,胎龄(28.52±1.10)周。2组患儿性别、胎龄、生后小时龄、出生体重和胸片分级比较差异均无统计学意义(均P>0.05)。辅助通气治疗前2组患儿SaO_(2)、PaO_(2)、PaCO_(2)比较差异均无统计学意义(均P>0.05),治疗24 h后HHHFNC组SaO_(2)、PaO_(2)均高于NCPAP组,而PaCO_(2)低于NCPAP组[(90.32±4.22)%比(82.76±3.68)%,(66.35±5.64)mmHg比(55.64±5.50)mmHg(1 mmHg=0.133 kPa),(40.15±5.22)mmHg比(46.24±5.19)mmHg,均P<0.001]。治疗24 h后HHHFNC组和NCPAP组SaO_(2)、PaO_(2)较治疗前均升高,而PaCO_(2)较治疗前均降低(均P<0.05)。HHHFNC组总住院时间、氧疗时间、开奶时间、建立全肠道喂养时间均短于NCPAP组[(23.51±5.79)d比(28.22±6.27)d,(10.15±1.16)d比(12.25±1.25)d,(30.21±3.46)h比(36.05±3.72)h,(12.36±1.33)d比(18.05±2.06)d,均P<0.001],2组患儿总辅助通气时间比较差异无统计学意义(P>0.05)。HHHFNC组鼻损伤发生率和并发症总发生率均低于NCPAP组[5.00%(3/60)比16.67%(10/60),8.33%(5/60)比20.00(12/60),均P<0.05],而腹胀、肺气漏发生率比较差异均无统计学意义(均P>0.05)。HHHFNC组EDIN量表中的5个条目得分和总分均低于NCPAP组(均P<0.001)。HHHFNC组辅助通气治疗的总有效率高于NCPAP组[95.00%(57/60)比83.33%(50/60),P<0.05]。结论:在轻度NRDS患儿中应用HHHFNC具有较好的疗效,且治疗时患儿发生并发症的风险降低。

Objective To observe the efficacy and complications of heated humidified high flow nasal cannula(HHHFNC)therapy for mild neonatal respiratory distress syndrome(NRDS).Methods This was an experimental study involving 120 children with mild NRDS admitted to the Affiliated Hospital of Jining Medical University from January 2019 to January 2022 selected by non-random sampling method.They were randomly assigned into HHHFNC group(60 cases,treated with HHHFNC)and nasal continuous positive airway pressure(NCPAP)group(60 cases,treated with NCPAP)by random number table method.General data(gender,gestational age,postnatal age in hours,birth weight and chest radiographic grade),blood gas indicators before and 24 hours after assisted ventilation(arterial oxygen saturation[SaO_(2)],arterial partial pressure of oxygen[PaO_(2)]and arterial partial pressure of carbon dioxide[PaCO_(2)]),clinical indicators(length of stay,duration for oxygen therapy,total assisted ventilation time,breastfeeding time and whole-intestinal feeding time),and complications(nasal injury,abdominal distension or pulmonary air leakage)were compared.The comfort level of the children was assessed using the EDIN scale(Échelle Douleur Inconfort Nouveau-Né,neonatal pain and discomfort scale).The efficacy of assisted ventilation therapy(HHHFNC or NCPAP)was assessed.Results There were 36 males and 24 females in the HHHFNC group,with a gestational age of(28.46±1.12)weeks.There were 34 males and 26 females in the NCPAP group,with a gestational age of(28.52±1.10)weeks.There were no significant differences in the gender,gestational age,postnatal age in hours,birth weight and chest radiographic grade between groups(all P>0.05).There were no significant differences in SaO_(2),PaO_(2) and PaCO_(2) between the two groups before assisted ventilation treatment(all P>0.05).After 24 h of treatment,SaO_(2)([90.32±4.22]%vs[82.76±3.68]%)and PaO_(2)([66.35±5.64]mmHg vs[55.64±5.50]mmHg,1 mmHg=0.133 kPa)in the HHHFNC group were significantly higher than those of the NCPAP group,while PaCO_(2)([40.15±5.22]mmHg vs[46.24±5.19]mmHg)was significantly lower(all P<0.001).After 24 h of treatment,SaO_(2) and PaO_(2) in both groups were significantly higher than before treatment,while PaCO_(2) was significantly lower than before treatment(all P<0.05).Length of stay([23.51±5.79]d vs[28.22±6.27]d),duration for oxygen therapy([10.15±1.16]d vs[12.25±1.25]d),breastfeeding time([30.21±3.46]h vs[36.05±3.72]h)and whole-intestinal feeding time([12.36±1.33]d vs[18.05±2.06]d)were all significantly shorter in the HHHFNC group than those of NCPAP group(all P<0.001).There was no significant difference in total assisted ventilation time between the two groups(P>0.05).The incidences of nasal injury(5.00%[3/60]vs 16.67%[10/60])and total complication(8.33%[5/60]vs 20.00[12/60])in the HHHFNC group were significantly lower than those of the NCPAP group(both P<0.05).There were no significant differences in the incidences of abdominal distension and pulmonary air leakage(both P>0.05).The scores and total scores of 5 items in the EDIN scale of HHHFNC group were significantly lower than those of NCPAP group(all P<0.001).The total effective rate of assisted ventilation therapy in the HHHFNC group was significantly higher than that of NCPAP group(95.00%[57/60]vs 83.33%[50/60],P<0.05).Conclusions The application of HHHFNC in children with mild NRDS has a good effect,and the risk of complications is reduced during treatment.