无创高频与加温湿化高流量鼻导管通气在早产儿呼吸窘迫综合征序贯撤机的临床应用  

Clinical application of noninvasive high frequency oscillatory ventilation and heated humidified high flow nasal cannula in sequential ventilator evacuation of premature infants with respiratory distress syndrome

作　　者：吴杰斌[1] 翟敬芳[2] 刘枭 金宝[1] 王彦波 周广玲[1] 周彬[1] Wu Jiebin;Zhai Jingfang;Liu Xiao;Jin Bao;Wang Yanbo;Zhou Guangling;Zhou Bin(Pediatric Department,Xuzhou Clinical School of Xuzhou Medical University,Xuzhou Central Hospital,Xuzhou 221009,China;Perinatal Medical Center,Xuzhou Clinical School of Xuzhou Medical University,Xuzhou Central Hospital,Xuzhou 221009,China)

机构地区：[1]徐州市中心医院徐州医科大学徐州临床学院儿科,221009 [2]徐州市中心医院徐州医科大学徐州临床学院围产医学中心,221009

出　　处：《中国小儿急救医学》2021年第3期165-170,共6页Chinese Pediatric Emergency Medicine

基　　金：徐州市科学技术局重点研发计划项目(KC18185);江苏省妇幼健康科研项目(F201942)。

摘　　要：目的:探讨经鼻无创高频振荡通气(noninvasive high frequency oscillatory ventilation,nHFOV)与加温湿化高流量鼻导管通气(heated humidified high flow nasal cannula,HHHFNC)在极低出生体重早产儿呼吸窘迫综合征(respiratory distress syndrome,RDS)序贯撤机的临床应用。方法:将2017年5月至2020年1月收住徐州市中心医院新生儿重症监护病房(neonatal intensive care unit,NICU)已接受气管插管有创通气治疗,准备撤机改为无创通气的88例RDS极低出生体重儿纳入研究。RDS患儿均常规给予枸橼酸咖啡因治疗,采用随机数字表法,将患儿分为nHFOV/HHHFNC组45例,采用有创通气撤机后予nHFOV,nHFOV撤离后给予HHHFNC过渡;经鼻持续气道正压通气(nasal continuous positive airway pressure,nCPAP)/头罩吸氧组43例,采用有创通气撤机后予nCPAP,nCPAP撤离后给予头罩吸氧过渡。观察2组有创通气撤机后动脉血气分析指标、撤机效果及并发症发生率。结果:(1)2组性别、胎龄、出生体重、生后1 min及5min Apgar评分、分娩24 h前使用糖皮质激素比例、使用肺表面活性物质比例、有创通气时间以及RDS分级情况比较,差异均无统计学意义( P>0.05)。(2)nHFOV/HHHFNC组有创通气撤机后1 h、24 h PaO_(2)、PaCO_(2)以及氧合指数(OI,OI=100×MAP×FiO_(2)/PaO_(2))与nCPAP/头罩吸氧组比较,差异均有统计学意义( P<0.05);nHFOV/HHHFNC组与nCPAP/头罩吸氧组有创通气撤机72 h内失败率[9%(4/45)比26%(11/43)]、频繁呼吸暂停发生率[7%(3/45)比23%(10/43)]、nHFOV与nCPAP无创通气撤离失败率[4%(2/45)比21%(9/43)]、用氧时间[12.02(9.08-12.31)d比14.44(11.32-13.26)d]及鼻损伤发生率[4%(2/45)比26%(11/43)]比较,差异均有统计学意义( P<0.05)。(3)2组首次nHFOV与nCPAP无创通气时间差异无统计学意义( P>0.05);2组肺气漏、坏死性小肠结肠炎、Ⅲ-Ⅳ级脑室内出血、视网膜病变(≥Ⅱ期)、支气管肺发育不良发生率及病死率比较,差异均无统计学意义(Objective To investigate the clinical application of noninvasive high frequency oscillatory ventilation(nHFOV)and heated humidified high flow nasal cannula(HHHFNC)in sequential ventilator evacuation of preterm infants with very low birth weight with respiratory distress syndrome(RDS).Methods A total of 88 preterm infants of very low birth weight with RDS were enrolled in the study,who had received endotracheal intubation invasive ventilation and were ready to be replaced by non-invasive ventilation at neonatal intensive care unit(NICU)of Xuzhou Central Hospital from May 2017 to January 2020.All premature infants were routinely treated with caffeine citrate.They were divided into two groups through random number table:nHFOV/HHHFNC group(45 cases)and continuous positive airway pressure(nCPAP)/oxygen hood group(43 cases).nHFOV was given after invasive ventilator removal and HHHFNC transition was followed after nHFOV withdrawal in the nHFOV/HHHFNC group,while nCPAP was given after invasive ventilator removal and oxygen hood was followed after nCPAP withdrawal in the nCPAP/oxygen hood group.The main observation consequences were compared with arterial blood gas indexes after invasive ventilator evacuation,weaning effect and the incidence of related complications.Results(1)There were no statistically differences between the two groups in terms of gender,gestational age,birth weight,Apgar score at 1 min and 5 min after birth,the number of glucocorticoid usage in 24 h before delivery,the number of pulmonary surfactant usage,invasive ventilation time and RDS grading(P>0.05).(2)The PaO_(2),PaCO_(2) and oxygenation index(OI=100×MAP×FiO_(2)/PaO_(2))of the nHFOV/HHHFNC group at 1 h and 24 h after invasive ventilator removal showed significant difference compared with the nCPAP/oxygen hood group(P<0.05).The differences as the following listed were statistically significant(P<0.05)between the two groups,including the failure rate of invasive ventilation weaning during 72 h[9%(4/45)vs.26%(11/43)],the incidence of frequent apne

关 键 词：无创高频振荡通气 加温湿化高流量鼻导管通气 呼吸机撤离 呼吸窘迫综合征 早产 极低出生体重 

分 类 号：R722.6[医药卫生—儿科]