应用加温湿化高流量鼻导管通气预防新生儿拔管失败的临床研究  

Efficacy and safety of heated humidified high-flow nasal cannula for prevention of extubation failure in neonates

机构地区：[1]河北省新生儿加温湿化高流量鼻导管通气研究协作组

出　　处：《中华儿科杂志》2014年第4期271-276,共6页Chinese Journal of Pediatrics

基　　金：河北省医学适用技术跟踪项目（GL2012013）;河北省人才培养工程资助（2012-334）

摘　　要：目的 通过与经鼻持续气道正压（NCPAP）效果比较,分析加温湿化高流量鼻导管通气（HHHFNC）在预防新生儿拔管失败方面的安全性和有效性.方法 由12家三级医院新生儿重症监护病房组成HHHFNC研究协作组,采用前瞻性临床随机对照方法,在2012年12月至2013年5月间根据以下入选标准纳入研究对象,入选标准：生后7d内进入新生儿重症监护病房,准备拔除气管插管改为无创辅助呼吸的患儿,出生体重及胎龄不限.按照随机数字表法将纳入对象分为HHHFNC组和NCPAP组,比较两组患儿拔管失败率、院内病死率以及支气管肺发育不良（BPD）的发生率及不良事件发生率.结果 共纳入研究对象255例,其中HHHFNC组128例,NCPAP组127例,两组在胎龄、体重、入选时日龄、性别比等方面差异无统计学意义（P＞0.05）;两组患儿在插管机械通气时间、无创辅助通气时间、氧疗时间、住院天数、达经口足量喂养天数方面比较差异均无统计学意义（P＞0.05）;入选病例总的院内病死率为10.6％ （27/255）;7d内发生拔管失败再次插管的共24例,发生率9.4％;极低出生体重儿发生拔管失败的比例为29.0％;两组患儿总的拔管失败率（9.4％ vs.9.4％）、病死率（9.4％ vs.11.8％）、BPD发生率（7.0％ vs.7.9％）,差异均无统计学意义（P＞0.05）;NCPAP组患儿腹胀发生率（12.6％）高于HHHFNC组（5.5％）（P＜0.05）.结论 HHHFNC在预防机械通气患儿拔管失败上效果与NCPAP相当,且未增加院内病死率及BPD、肺气漏发生率.Objective To assess the efficacy and safety of heated humidified high-flow nasal cannula （HHHFNC） ventilation compared with nasal continuous positive airway pressure （NCPAP） on prevention of extubation failure in the NICUs.Method A prospective randomized,controlled un-blinded study was conducted in 12 tertiary hospitals in Hebei Province from December 1,2012 to May 31,2013.Neonates were eligible for this study if they were admitted to the participating NICUs within 7 days of postnatal age,and needed noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube.Infants were randomly assigned to either HHHFNC or NCPAP group.The primary outcome measures included：the incidence of extubation failure,bronchopulmonary dysplasia and the mortality before discharge.Result Among the 255 cases included,128 were in the HHHFNC group,and 127 were in the NCPAP group.There was no significant difference in gestational age,birth weight,and age at randomization,and male/female ratio between the two groups （P ＞ 0.05）.There were no significant differences between groups for days on ventilation,noninvasive respiratory support,oxygen requirement,hospital stay and time to full oral feedings （P ＞ 0.05）.The overall mortality of the studied population was 10.6％ （27/255）.The occurrence of extubation failure within 7 days was 9.4％ whereas 29.0％ in very low birth weight infants.There was no significant difference in the extubation failure for HHHFNC （12/128,9.4％） versus NCPAP （12/127,9.4％） （P ＞ 0.05）,or in mortality for HHHFNC （12/128,9.4％） versus NCPAP （15/127,11.8％） （P ＞ 0.05）.No significant difference was found between the study groups in the occurrence of bronchopulmonary dysplasia （BPD） and most of severe adverse outcomes analyzed,including air leak syndrome and nasal trauma.The occurrence of abdominal distention during treatment was higher in NCPAP than HHHFNC group （12.6％ vs.5.5％,P ＜ 0.05）.Conclusion Among infants ≤ 7

关 键 词：婴儿 新生 连续气道正压通气 加温湿化高流量鼻导管通气 

分 类 号：R722.1[医药卫生—儿科]