两种无创呼吸支持方式治疗新生儿湿肺疗效比较  

Comparison on Therapeutic Effect of Two Noninvasive Respiratory Support Therapy on Transient Tachypnea of Newborn

作　　者：杨宁[1] 苗春月 王文娟 YANG Ning;MIAO Chunyue;WANG Wenjuan(Dezhou People’s Hospital,Dezhou 253000,China)

机构地区：[1]山东省德州市人民医院,山东德州253000

出　　处：《中国医学创新》2020年第27期1-6,共6页Medical Innovation of China

基　　金：山东省医药卫生科技发展计划项目(2018WS442)。

摘　　要：目的:评价使用加温湿化高流量鼻导管通气(heated humidified high-flow nasal cannula,HHHFNC)和经鼻持续正压通气(nasal continuous positive airway pressure,NCPAP)治疗新生儿湿肺(transient tachypnea of newborn,TTN)的有效性和安全性。方法:回顾性分析2016年9月-2018年9月德州市人民医院新生儿重症监护病房(neonatal intensive care unit,NICU)收治的新生儿湿肺患儿64例,根据入院后无创通气模式不同分为HHHFNC组30例与NCPAP组34例。比较两组上机前(0 h)和上机后12、72 h动脉血气变化、临床疗效及并发症发生情况。结果:两组各时点PaO2、PaCO2及OI比较,差异均无统计学意义(P>0.05),但两组上机后12、72 h PaO2、PaCO2及OI均较0 h明显提高(P<0.05)。所有患儿均治愈出院,两组无创呼吸机使用时间、氧疗时间及住院时间比较,差异均无统计学意义(P>0.05),HHHFNC组开奶时间、达全肠道喂养时间、恢复出生体重时间均较NCPAP组缩短,差异均有统计学意义(P<0.05)。两组呼吸暂停、肺气漏、持续肺动脉高压、呼吸窘迫综合征发生率比较,差异均无统计学意义(P>0.05)。两组无创通气失败重新气管插管率比较,差异无统计学意义(P>0.05)。NCPAP组鼻部损伤与喂养不耐受发生率均高于HHHFNC组,差异均有统计学意义(P<0.05)。结论:HHHFNC治疗新生儿湿肺效果确切,能与NCPAP达到同样的改善通气功能和氧合功能的作用,能使患儿开奶时间提前,缩短患儿达全肠道喂养时间与恢复出生体重时间,降低喂养不耐受和鼻部损伤的发生率,值得临床推广应用。Objective:To assess the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) ventilation and nasal continuous positive airway pressure (NCPAP) ventilation in the treatment of transient tachypnea of newborn (TTN).Method:A retrospective analysis was performed on 64 cases with TTN admitted to the neonatal intensive care unit (NICU) of Dezhou People’s Hospital from September 2016 to September 2018.According to the different non-invasive ventilation patterns after admission,they were divided into HHHFNC group (n=30) and NCPAP group (n=34).The changes of arterial blood gas before ventilation (0 h) and at 12,72 h after ventilation,clinical efficacy and complications were compared between two groups.Result:There were no significant differences in PaO2,PaCO2 and oxygenation index between two groups at each time (P>0.05),but PaO2,PaCO2 and oxygenation index of two groups at 12 and 72 h after ventilcation were significantly increased than those at 0 h (P<0.05).All patients were cured and discharged.There were no statistical significance in non-invasive respiratory support time,oxygen therapy time and hospitalization time between two groups (P>0.05).The milk opening time,the full enteral feeding time and the time to regain birth weight in HHHFNC group were shorter than those in NCPAP group,and the differences were statistically significant (P<0.05).There were no significant differences in the incidence of apnea,pneumothorax,persistent pulmonary hypertension and respiratory distress syndrome between two groups (P>0.05).There was no significant difference in the rate of reintubation after failure of non-invasive ventilation between two groups (P>0.05).The incidence of nasal injury and feeding intolerance in NCPAP group was higher than those in HHHFNC group,and the differences were statistically significant (P<0.05).Conclusion:Compared with NCPAP,the efficacy of HHHFNC in the treatment of TTN is accurate,and it can improve ventilation function and oxygenation function,advance the time of breast-opening fe

关 键 词：加温湿化高流量鼻导管通气 经鼻持续气道正压通气 新生儿湿肺 

分 类 号：R722.1[医药卫生—儿科]