不同辅助通气方式预防超低出生体重早产儿拔管失败的临床研究  

Comparison of heated humidified high flow nasal cannula and nasal continuous positive airway pressure for prevention of extubation failure in extremely low birth weight infants

作　　者：陈佳[1] 许芳[1] 张涛[1] 杜岚岚[1] 高薇薇[1] 

机构地区：[1]广东省妇幼保健院新生儿科,广州511400

出　　处：《中国新生儿科杂志》2016年第2期86-90,共5页Chinese Journal of Neonatology

基　　金：广东省医学科研项目(A2011076)

摘　　要：目的探讨加温湿化经鼻导管高流量通气(HHHFNC)应用于超低出生体重早产儿撤机后的临床疗效。方法选择2011年1月至2014年12月生后7天内收入本院新生儿重症监护病房胎龄<34周、体重<1 000 g的早产儿,准备拔除气管插管改为无创辅助呼吸时纳入本研究。将纳入对象随机分为HHHFNC组和鼻塞式持续气道正压通气(NCPAP)组,观察患儿临床症状改善情况、总辅助通气时间、无创辅助通气时间、总用氧时间、达到全肠道喂养时间、撤机失败率及各种并发症发生率。结果共纳入129例早产儿,其中HHHFNC组66例,NCPAP组63例。与NCPAP组相比,HHHFNC组总用氧时间[20.0(15.0,32.5)天比23.5(16.0,34.0)天]和达到全肠道喂养时间[20.5(15.5,25.5)天比22.5(16.5,28.0)天]明显缩短,7天内重新插管率(25.8%比47.6%)、鼻部损伤率(6.1%比47.6%)、气漏(6.1%比23.8%)、腹胀(9.1%比25.4%)和坏死性小肠结肠炎(10.6%比28.6%)发生率均明显降低,差异有统计学意义(P<0.05)。两组总辅助通气时间、无创辅助通气时间、3天内重新插管率及支气管肺发育不良、早产儿视网膜病、颅内出血、脑白质软化、动脉导管未闭发生率差异无统计学意义(P>0.05)。结论与NCPAP相比,HHHFNC在预防机械通气超低出生体重早产儿拔管失败上效果较好,缩短了用氧时间,明显降低鼻部损伤、腹胀、坏死性小肠结肠炎和气漏的发生率。Objective To study the efficacy and safety of heated humidified high flow nasal cannula（ HHHFNC） and nasal continuous positive airway pressure（ NCPAP） ventilation for prevention of extubation failure in extremely low birth weight（ ELBW） infants in our NICU. Methods From Jan. 2011 to Dec. 2014,129 ELBW infants admitted to our hospital were randomly assigned into HHHFNC group and NCPAP group. The inclusion criteria were gestational age（ GA） 34 w,birth weight（ BW） 1 000 g,admission within 7 d after birth and transition to noninvasive respiratory support after a period of mechanical ventilation with an endotracheal tube. The primary outcome included： the incidence of extubation failure,nasal injury,air leak,abdominal distention and bronchopulmonary dysplasia（ BPD）.Results Statistically significant differences existed between the two groups on oxygen therapy duration,the time required reaching total enteral feedings and the incidences of nasal injury,air leak,abdominal distention and necrotizing enterocolitis（ P〈0. 05）. The incidence of extubation failure within 7 days was25. 8% in HHHFNC group and 47. 6% in NCPAP group（ P〈0. 05）. No differences between the2 groups on total ventilation duration,non-invasive ventilation duration,re-intubation rate at 3d after extubation,BPD,retinopathy of prematurity（ ROP）,intracerebral hemorrhage（ ICH）,periventricular leukomalacia（ PVL） and patent ductus arteriosus（ PDA）. Conclusions HHHFNC is an effective and safe method for prevention of extubation failure in ELBW infants.

关 键 词：婴儿 超低出生体重 婴儿 早产 经鼻导管高流量通气 连续气道正压通气 

分 类 号：R722.6[医药卫生—儿科]