HHHFNC治疗新生儿Ⅰ型呼吸衰竭疗效观察  

Efficacy of heated humidified high flow nasal cannula for treatment of neonates with type Ⅰ respiratory failure

作　　者：王凤[1] 郑晓燕[1] 刘卫鹏[1] 屈素清[1] 

机构地区：[1]中国人民解放军海军总医院儿科,北京100048

出　　处：《中国妇幼健康研究》2017年第9期1081-1083,共3页Chinese Journal of Woman and Child Health Research

摘　　要：目的观察加温湿化经鼻导管高流量通气(HHHFNC)治疗新生儿Ⅰ型呼吸衰竭的疗效。方法将2014年10月至2016年5月中国人民解放军海军总医院收治的82例Ⅰ型呼吸衰竭新生儿按随机排列表法分成HHHFNC组40例和经鼻持续气道正压通气(nCPAP)组42例。比较两组通气后1h和24h血气分析指标、变更有创通气率、并发症发生率。结果 HHHFNC组1h、24h PaCO_2较nCPAP组低,差异均有统计学意义(t值分别为2.656、3.141,均P<0.05)。HHHFNC组患儿喂养不耐受(χ~2=4.518,P=0.033)、鼻部压疮发生率明显低于nCPAP组(Fisher精确P=0.009),差异均有统计学意义(均P<0.05)。HHHFNC组患儿无气漏症病例,而nCPAP组气胸发生率为9.5%,均为足月儿,在足月儿中发生率达33.3%。结论与nCPAP相比较时,HHHFNC在治疗Ⅰ型新生儿呼吸衰竭时虽然氧合及远期并发症无统计学差异,但可减少二氧化碳潴留,对于早产儿可减少鼻部压疮及喂养不耐受的发生,可能减少足月儿气漏伤的发生。故在各类疾病导致的Ⅰ型呼吸衰竭中,HHHFNC可能成为替代nCPAP的有效无创通气方法之一。Objective To study the clinical efficacy of heated humidified high flow nasal cannula（ HHHFNC） for the treatment of neonates with type Ⅰ respiratory failure. Methods Eighty-two neonates with type Ⅰ respiratory failure admitted in Navy General Hospital between October 2014 and May 2016 were randomly assigned to two groups according to random table method,HHHFNC group（ n = 40） and nasal continuous positive airway pressure（ nCPAP） group（ n = 42）. Arterial blood gas analysis indexes at 1h and 24 h after ventilation,incidence of changing to invasive ventilation and complications were compared between two groups. Results Compared to nCPAP group,PaCO_2 at 1h and 24 h was significantly lower in HHHFNC group（ t value was 2. 656 and 3. 141,respectively,both P 0. 05）. The incidences of feeding intolerance（ χ~2 = 4. 518,P = 0. 033） and nasal pressure sore were significantly lower in HHHFNC group than in nCPAP group（ P = 0. 009）（ both P 0. 05）. There was no case of frequent hemorrhoid in HHHFNC group. But in nCPAP group the incidence was 9. 5% and all of cases were full-term neonates,which occupied 33. 3% of neonates. Conclusion Although HHHFNC is not statistically different from nCPAP in oxygenation and long-term complications in treatment of type Ⅰ respiratory failure,it can reduce carbon dioxide retention and the incidence of nasal pressure sore and feeding intolerance as well as full-term frequent hemorrhoid. HHHFNC maybe a substitution of nCPAP for the treatment of neonates with type Ⅰ respiratory failure induced by different sorts of neonatal disease.

关 键 词：加温湿化经鼻导管高流量通气 经鼻持续气道正压通气 呼吸衰竭 新生儿 

分 类 号：R725.6[医药卫生—儿科]