HHHFNC与nCPAP治疗早产儿呼吸窘迫综合征多中心研究  

A multicenter study of HHHFNC and nCPAP in the treatment of premature infants with RDS

作　　者：杨军 台晓燕[2] 罗厚江[1] 姜开军[3] 汪灵芝[1] 刘敏敏 陈茹茹 YANG Jun;TAI Xiao-yan;LUO Hou-jiang;JIANG Kai-jun;WANG Ling-zhi;LIU Min-min;CHEN Ru-ru(Department of Pediatrics,The Second Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233040;Department of Pediatrics,The First Affiliated Hospital of Bengbu Medical College,Bengbu Anhui 233004;Department of Neonatology,Bengbu Children′s Hospital,Bengbu Anhui 233000,China)

机构地区：[1]蚌埠医学院第二附属医院儿科,安徽蚌埠233040 [2]蚌埠医学院第一附属医院儿科,安徽蚌埠233004 [3]蚌埠市儿童医院新生儿科,安徽蚌埠233000

出　　处：《蚌埠医学院学报》2023年第5期577-581,共5页Journal of Bengbu Medical College

基　　金：蚌埠医学院自然科学研究重点项目(BYKY2019158ZD)。

摘　　要：目的:探讨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)治疗早产儿呼吸窘迫综合征(RDS)的临床效果。方法:采用多中心前瞻性临床随机对照研究方法,将三家治疗中心诊断为RDS需要无创呼吸支持的早产儿260例纳入研究,根据体质量分为≤1500 g组120例和>1500 g组140例,再按照随机分组原则将每组分为HHHFNC组和nCPAP组。比较各组主要观察指标(治疗失败率、再插管率、医院内病死率、无创通气时间和用氧时间)和次要观察指标[鼻损伤、腹胀、肺气漏、Ⅲ~Ⅳ级颅内出血(IVH)和败血症发生率]。结果:主要观察指标比较,体质量≤1500 g组:HHHFNC组无创通气时间和用氧时间均明显高于nCPAP组(P<0.01),2组治疗失败率、医院内病死率和再插管率差异均无统计学意义(P>0.05);体质量>1500 g组:HHHFNC组与nCPAP组治疗失败率、无创通气时间、用氧时间、医院内病死率和再插管率差异均无统计学意义(P>0.05)。次要观察指标比较,体质量≤1500 g组:HHHFNC组鼻损伤和腹胀发生率均明显低于nCPAP组(P<0.01),2组肺气漏、Ⅲ~Ⅳ级IVH及败血症发生率差异均无统计学意义(P>0.05);体质量>1500 g组:HHHFNC组鼻损伤发生率明显低于nCPAP组(P<0.01),2组腹胀、肺气漏、Ⅲ~Ⅳ级IVH及败血症发生率差异均无统计学意义(P>0.05)。结论:HHHFNC可作为体质量>1500 g早产儿轻中度RDS的首选呼吸支持模式。Objective:To explore the clinical effect of heated humidified high flow nasal cannula(HHHFNC)and nasal continuous positive airway pressure(nCPAP)in the treatment of premature infants with respiratory distress syndrome(RDS).Methods:A multicenter,prospective,randomized controlled clinical study was carried out.Two hundred and sixty premature infants diagnosed with RDS requiring non-invasive respiratory support in three treatment centers were included in the study.According to the body mass,the infants were divided into the body mass≤1500 g group(n=120)and body mass>1500 g group(n=140),then the two groups were randomly subdivided into the HHHFNC group and nCPAP group.The primary observation indexes(treatment failure rate,re-intubation rate,hospital mortality rate,non-invasive ventilation time and oxygen use time)and the secondary observation indexes[the incidence of nasal injury,abdominal distension,pulmonary air leakage,gradeⅢ-Ⅳintra-ventricular hemorrhage(IVH)and sepsis]were compared among the groups.Results:As for the primary observation indexes,in the body mass≤1500 g group,the non-invasive ventilation time and oxygen use time in the HHHFNC group were significantly higher than those in the nCPAP group(P<0.01),and there were no significant differences in the treatment failure rate,hospital mortality rate and re-intubation rate between the two groups(P>0.05);in the body mass>1500 g group,there were no significant differences in the treatment failure rate,non-invasive ventilation time,oxygen use time,hospital mortality rate and re-intubation rate between the HHHFNC group and nCPAP group(P>0.05).As for the secondary observation indexes,in the body mass≤1500 g group,the incidence of nasal injury and abdominal distension in the HHHFNC group were significantly lower than those in the nCPAP group(P<0.01),and there were no significant differences in the incidence of pulmonary air leakage,gradeⅢ-ⅣIVH and sepsis between the two groups(P>0.05);in the body mass>1500 g group,the incidence of nasal injury in the

关 键 词：呼吸窘迫综合征 加温湿化高流量鼻导管通气 经鼻持续气道正压通气 早产儿 

分 类 号：R72[医药卫生—儿科]