无创高频振荡通气模式在极低出生体重儿呼吸支持中的应用  

Use of noninvasive high-frequency oscillatory ventilation in very low birth weight infants

作　　者：王陈红[1] 施丽萍[1] 马晓路[1] 林慧佳[1] 许燕萍[1] 杜立中[1] Wang Chenhong Shi Liping Ma Xiaolu Lin Huijia Xu Yanping Du Lizhong

机构地区：[1]浙江大学医学院附属儿童医院新生儿重症监护病房,杭州310051

出　　处：《中华儿科杂志》2017年第3期177-181,共5页Chinese Journal of Pediatrics

基　　金：国家自然科学基金（81630037、81471480）

摘　　要：目的 评价经鼻无创高频振荡通气（nHFOV）在极低出生体重儿呼吸支持中的有效性和安全性.方法 2016年1至10月浙江大学医学院附属儿童医院新生儿重症监护病房（NICU）中共有36例极低出生体重儿应用nHFOV,其中男24例、女12例,出生胎龄（27.5±2.5）周,出生体重（980 ±318）g,回顾性病例对照的方法调查分析极低出生体重儿应用nHFOV的参数设置、不良反应、应用前后呼吸功能的变化及最终结果.nHFOV应用前后比较采用t检验或两相关样本比较的非参数检验,不同治疗方式组间比较采用x2检验.结果 36例患儿中共有32例（89％）切换为nHFOV后避免了气管插管.17例患儿在其他无创辅助通气支持失败后进行营救性治疗,19例从气管插管机械通气模式直接改nHFOV预防性治疗.营救性治疗患儿应用nHFOV后24 h内呼吸暂停的次数、血氧饱和度（SpO2）低于0.85的次数、动脉血二氧化碳分压（PaCO2）水平及吸入氧浓度（FiO2）均较应用前24 h内明显下降[（1.2±1.1）比（6.3±2.1）次,（1.1±1.2）比（4.3±1.5）次,（43±8）比（56±10） mmHg,0.30±0.07比0.39 ±0.11,1 mmHg =0.133 kPa,t=7.562、8.913、4.179、3.437,P均＜0.01].预防性治疗患儿应用nHFOV后24 h FiO2及PaCO2水平与应用前差异均无统计学意义[0.42 ±0.12比0.40 ±0.10,（49±8）mmHg比（48±7）mmHg,t=0.872、0.501,P均＞0.05],但平均气道压较前下降[（7.9±2.6）比（9.6±1.6） cmH22O,1 cmH2O=0.098 kPa,t=2.198,P=0.041].4例患儿发生鼻中隔黏膜损伤,无其他不良反应.结论 nHFOV作为一种新的无创辅助通气模式在极低出生体重儿中的应用安全有效,可以作为其他无创辅助通气支持失败后的治疗或有撤机失败高风险患儿的预防性治疗,从而避免气管插管机械通气.Objective To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation （nHFOV） in very low birth weight infants.Method A total of 36 cases received nHFOV between January 2016 and October 2016 in Children＇s Hospital,Zhejiang University School of Medicine,including 24 males and 12 females,with the gestational age of （27.5 ± 2.5） weeks and birth weight of（980 ± 318）g.The data of the ventilator settings,side effects,and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively.Nonparametric tests or t tests or x2 tests were used.Result Thirty-two （89%） out of the 36 cases successfully avoided intubation or reintubation after using of nHFOV.nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases,and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases.There were significant decreases in the incidences of apnea and desaturation （SpO2 〈 0.85）,the level of PaCO2,and the FiO2 24 h after the initiation of the nHFOV as the rescue therapy （（1.2±1.1）vs.（6.3±2.1）episodes,（1.1 ±1.2） vs.（4.3 ±1.5） episodes,（43±8） vs.（56±10） mmHg,0.30 ± 0.07 vs.0.39 ± 0.11,respectively;1 mmHg =0.133 kPa,t =7.562,8.913,4.179,3.437 respectively,all P 〈 0.01）.No significant changes were found in FiO2 and PaCO2 levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation （0.42 ± 0.12 vs.0.40 ± 0.10,（49 ± 8） vs.（48 ± 7） mmHg,t =0.872 and 0.501 respectively,both P 〉 0.05）,except for the significant decreases in the mean airway pressure （（7.9 ± 2.6） vs.（9.6 ± 1.6） cmH2O,1 cmH2O =0.098 kPa,t =2.198,P =0.041）.There were 4 cases suffered from nasal septum injury,while no other nHFOV related complications were noted.Conclusion nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation,or prophylactically used i

关 键 词：婴儿 极低出生体重 支气管肺发育不良 高频通气 无创辅助通气 

分 类 号：R722.6[医药卫生—儿科]