HHFNC和NCPAP在早产儿机械通气撤机中的应用  

Clinical application of HHFNC and NCPAP for weaning from mechanical ventilation in preterm infants

作　　者：魏贤[1] 甘斌[1] 何源[1] 黄杰[1] 易海英[1] 杨树杰[1] Wei Xian;Gan Bin;He Yuan;Huang Jie;Yi Haiying;Yang Shujie(Department of Neonatology,Xiaogan Central Hospital Affiliated to Wuhan University of Science and Technology,Xiaogan 432000,China)

机构地区：[1]武汉科技大学附属孝感市中心医院新生儿科,湖北孝感432000

出　　处：《河南医学研究》2018年第4期594-597,共4页Henan Medical Research

基　　金：中国航天科工集团2016年医疗卫生科研项目(2016-LCYL-017)

摘　　要：目的探讨加热湿化高流量鼻导管通气(HHFNC)和鼻塞式持续气道正压通气(NCPAP)在早产儿机械通气撤机中的临床应用效果。方法选择2015年1月至2016年12月在武汉科技大学附属孝感市中心医院新生儿重症监护室(NICU)住院治疗的极低体质量儿(VLBW)作为研究对象进行前瞻性研究。患儿撤机后按照随机数表法分为HHFNC组和NCPAP组,比较两组患儿的临床应用效果。结果两组患儿撤机后治疗12、24 h的动脉氧分压(PaO_2)、二氧化碳分压(PaCO_2)、动脉/肺泡氧分压(a/APO_2)较治疗后1 h改善(P均<0.05),两组间1、12、24 h的PaO_2、PaCO_2、a/APO_2比较,差异无统计学意义(P>0.05);两组患儿无创通气时间、总吸氧时间、达全肠道营养时间、总住院时间、撤机失败率比较,差异无统计学意义(P>0.05);HHFNC组患儿鼻损伤、腹胀发生率低于NCPAP组(P<0.05),两组气漏、动脉导管未闭(PDA)、早产儿视网膜病变(ROP)、Ⅲ~Ⅳ级脑室内出血(IVH)发生率比较,差异无统计学意义(P>0.05)。结论撤机后使用HHFNC和NCPAP效果相当,但HHFNC对患儿的损伤相对较轻。Objective To investigate the effectiveness of humidified high flow nasal cannula(HHFNC)and nasal continuous positive airway pressure(NCPAP)for weaning from mechanical ventilation in preterm infants.Methods The very low birth weight infants(VLBW)treated in NICU of Xiaogan Central Hospital Affiliated to Wuhan University of Science and Technology from January of 2015 to December of 2016 were choosed.The patients were randomly divided into HHFNC group and NCPAP group,then the clinical application effects of HHFNC and NCPAP for weaning from mechanical ventilation were compared between two groups.Results Compared with the beginning of one hour after treatment,the levels of the PaO 2、PaCO 2 and a/APO 2 were improved significantly at the beginning of twelve and twenty four hours after treatment(P<0.05).There was no significantly statistical difference in the level of PaO 2,PaCO 2 and a/APO 2 between two groups at the beginning of one,twelve and twenty four hours after treatment(P>0.05).The differences of the non-invasive ventilation time,total oxygen therapy time,achieving all enteral nutrition time,total length of stay in hospital and failure rate of extubation were not statistically significant(P>0.05).The incidence rates of the nasal injury and abdominal distension in HHFNC group were lower than NCPAP group(P<0.05).The differences of the incidence rates of the frequent hemorrhoid,PDA,ROP andⅢtoⅣdegree of IVH were not statistically significant(P>0.05).Conclusion The treatment effectiveness of the HHFNC and NCPAP are equivalent in weaning from mechanical ventilation in preterm infants,but the injuries induced by HHFNC are relative slight.

关 键 词：高流量鼻导管通气 持续气道正压通气 机械通气 早产儿 

分 类 号：R722.1[医药卫生—儿科]