加温湿化高流量鼻导管吸氧在32周以下早产儿撤机中的疗效比较  

Efficacy of heated humidified high-flow nasal cannula in preterm infants aged less than 32 weeks after ventilator weaning

作　　者：康文清[1] 许邦礼[1] 刘大鹏[1] 张耀东[1] 郭静[1] 李朝晖[1] 周炎娟[1] 熊虹[1] 

机构地区：[1]郑州市儿童医院NICU/郑州市新生儿疾病研究重点实验室,河南郑州450018

出　　处：《中国当代儿科杂志》2016年第6期488-491,共4页Chinese Journal of Contemporary Pediatrics

基　　金：郑州市普通科技攻关项目(20140510)

摘　　要：目的观察26~31^(+6)周呼吸窘迫综合征早产儿撤机后应用加温湿化高流量鼻导管吸氧(HHHFNC)和鼻塞持续气道正压(nCPAP)的疗效。方法 161例早产儿拔管后随机分成两组:治疗组接受HHHFNC治疗(n=79);对照组接受nCPAP治疗(n=82)。两组患儿又根据胎龄分为26~28^(+6)周组和29~31^(+6)周组。比较组间治疗失败率、拔管后7d内再次插管率、并发症发生率和住院期间病死率。结果治疗组和对照组两组早产儿治疗失败率和再插管率差异无统计学意义。胎龄26~28^(+6)周的早产儿中,治疗组治疗失败率显著高于对照组(P<0.05),再次插管率差异无统计学意义;29~31^(+6)周早产儿中,两组治疗失败率和再次插管率差异均无统计学意义。两组患儿并发症发生率和病死率差异亦无统计学意义。结论对29~31^(+6)周的早产儿撤机时应用HHHFNC能产生与nCPAP相似疗效,而对29周以下早产儿作为一线无创呼吸支持要谨慎。ObjectiveTo investigate the efifcacy of heated humidiifed high-lfow nasal cannula （HHHFNC） and nasal continuous positive airway pressure （nCPAP） in preterm infants aged 26-31＋6 weeks with respiratory distress syndrome after ventilator weaning.MethodsA total of 161 preterm infants were randomly divided into two groups after ventilator weaning： HHHFNC treatment （n=79） and nCPAP treatment （n=82）. The two groups were subdivided into 26-28＋6 weeks and 29-31＋6 weeks groups according to the gestational age. The treatment failure rate, reintubation rate within 7 days after extubation, incidence of complications, and mortality during hospitalization were compared between the two groups.ResultsThe treatment failure rate and reintubation rate showed no signiifcant differences between the HHHFNC and nCPAP groups. The preterm infants aged 26-28＋6 weeks in the HHHFNC group had a signiifcantly higher treatment failure rate than those in the nCPAP group （P〈0.05）, while the reintubation rate showed no signiifcant difference. As for the preterm infants aged 29-31＋6 weeks, the treatment failure rate and reintubation rate showed no significant differences between the two groups. The incidence of complications and mortality showed no significant differences between the HHHFNC and nCPAP groups.ConclusionsIn preterm infants aged 29-31＋6 weeks, HHHFNC has a similar efifcacy as nCPAP after ventilator weaning, while in those aged less than 29 weeks, HHHFNC should be used with great caution if selected as the ifrst-line noninvasive respiratory support.

关 键 词：加温湿化高流量鼻导管吸氧 鼻塞持续气道正压 撤机 早产儿 

分 类 号：R722.6[医药卫生—儿科]