加温湿化高流量鼻导管通气与经鼻持续气道正压通气对新生儿轻度呼吸困难的初始支持治疗分析  

Comparison of heated humidified high-flow nasal cannula and nasal continuous positive airway pressure in initial supportive support of mild neonatal respiratory distress

作　　者：余霞娟 陈雪雨 李霞芬 曹慧玲 钟进媚 杨勇 梅家平 YU Xia-juan;CHEN Xue-yu;LI Xia-fen(Shenzhen Maternal and Child Health Hospital Affiliated to Southern Medical University,Shenzhen 518000,China)

机构地区：[1]南方医科大学附属深圳妇幼保健院,518000

出　　处：《中国现代药物应用》2022年第21期162-166,共5页Chinese Journal of Modern Drug Application

基　　金：深圳市“医疗卫生三名工程”资助项目(浙江大学医学院附属儿童医院杜立中教授新生儿重症监护团队,项目编号:SZSM201612045);广东省高水平临床重点专科(深圳市配套建设经费,项目编号:SZGSP009);深圳市妇幼保健院院内科研基金项目护理专项(项目编号:FYB2018003)。

摘　　要：目的比较加温湿化高流量鼻导管通气(HHHFNC)与经鼻持续气道正压通气(NCPAP)对新生儿轻度呼吸困难患儿的初始支持治疗效果,分析患儿用氧时间的影响因素。方法218例孕周>32周、生后表现为轻度呼吸困难的新生儿,根据初始采用的呼吸支持方式不同分为HHHFNC组(120例)和NCPAP组(98例)。比较两组患儿临床资料、用氧时间、呼吸支持升级率、机械通气率、住院时间及并发症发生情况,应用多重线性回归分析轻度呼吸困难新生儿用氧时间的影响因素。结果两组孕周、出生体重、双胎占比、产前使用激素占比、妊娠期糖尿病占比、妊娠期高血压占比、1 min Apgar评分、5 min Apgar评分、生后氧合指数、吸入氧浓度(FiO2)比较差异具有统计学意义(P<0.05);两组剖宫产占比、男性占比、妊娠期肝内胆汁淤积占比、宫内感染占比比较差异无统计学意义(P>0.05)。HHHFNC组患儿的用氧时间46.0(23.0,97.0)h、住院时间7(5,10)d均明显短于NCPAP组的86.0(46.0,144.0)h、14(9,28)d,差异具有统计学意义(P<0.05);HHHFNC组患儿的呼吸支持升级率15.0%明显高于NCPAP组患儿的6.1%,差异具有统计学意义(P<0.05);两组患儿机械通气率比较差异无统计学意义(P>0.05)。HHHFNC组患儿鼻中隔损伤发生率0.8%显著低于NCPAP组的6.1%,差异具有统计学意义(P<0.05);两组患儿腹胀发生率比较差异无统计学意义(P>0.05)。多重线性回归分析发现:氧合指数是患儿用氧时间的独立影响因素[B=-0.252,95%CI=(-0.422,-0.083),P=0.004<0.05];初始呼吸支持方式、FiO2、孕周、出生体重、1 min Apgar评分、5 min Apgar评分、产前使用激素不是患儿用氧时间的独立影响因素(P>0.05)。结论本研究发现与NCPAP相比,HHHFNC作为轻度呼吸困难患儿的初始支持疗法,既可以减少鼻中隔损伤的风险,又不影响患儿的用氧时间,且不增加插管风险,不失为一个较好的呼吸支持方式。但本研究为回顾Objective To compare the clinical effects of heated humidified high-flow nasal cannula(HHHFNC)and nasal continuous positive airway pressure(NCPAP)in initial respiratory support to neonates with mild neonatal respiratory distress,and analyze the influencing factors of the duration of supplemental oxygen in neonates.Methods A total of 218 neonates with a gestational age of>32 weeks and mild respiratory distress after birth were divided into HHHFNC group(120 cases)and NCPAP group(98 cases)according to different initial respiratory support methods.Both groups were compared in terms of clinical data,duration of supplemental oxygen,rate of respiratory support escalation,rate of mechanical ventilation,hospital stay,and occurrence of complications,and multiple linear regression was used to analyze the influencing factors of oxygen use time for neonates with mild respiratory distress.Results The differences in gestational week,birth weight,proportion of twins,proportion of prenatal hormone use,proportion of gestational diabetes mellitus,proportion of gestational hypertension,1 min Apgar score,5 min Apgar score,postnatal oxygenation index,and fraction of inspired oxygen(FiO2)between the two groups were statistically significant(P<0.05).There was no statistically significant difference in the percentage of cesarean section,percentage of males,percentage of intrahepatic cholestasis during pregnancy,and percentage of intrauterine infections between the two groups(P>0.05).The duration of supplemental oxygen 46.0(23.0,97.0)h and hospital stay 7(5,10)d in the HHHFNC group were significantly shorter than 86.0(46.0,144.0)h and 14(9,28)d in the NCPAP group,and the differences were all statistically significant(P<0.05).The rate of respiratory support escalation in the HHHFNC group was 15.0%,which was significantly higher than 6.1%in the NCPAP group,and the difference was statistically significant(P<0.05).There was no statistically significant difference in the rate of mechanical ventilation between the two groups(P>0.05).The inciden

关 键 词：呼吸困难 新生儿 加温湿化高流量鼻导管通气 经鼻持续气道正压通气 用氧时间 住院时间 并发症 

分 类 号：R722.1[医药卫生—儿科]