加温湿化经鼻导管高流量通气治疗轻度NRDS的疗效及并发症  

Curative effect and complications of heated humidified high flow nasal cannula therapy on the treatment of mild neonatal respiratory distress syndrome

作　　者：田刚 陈莉 李自喜 林祥晓[1] 崔芹 田营营[2] 杨丹丹 张念珍 Tian Gang;Chen Li;Li Zixi;Lin Xiangxiao;Cui Qin;Tian Yingying;Yang Dandan;Zhang Nianzhen(Department of Respiratory and Critical Care Medicine,Affiliated Hospital of Jining Medical University,Jining 272029,China;Department of Respiratory Endoscopy,Affiliated Hospital of Jining Medical University,Jining 272029,China)

机构地区：[1]济宁医学院附属医院呼吸与危重症医学科,济宁272029 [2]济宁医学院附属医院呼吸内镜室,济宁272029

出　　处：《国际呼吸杂志》2024年第8期952-957,共6页International Journal of Respiration

摘　　要：目的:观察加温湿化经鼻导管高流量通气(HHHFNC)治疗轻度新生儿呼吸窘迫综合征(NRDS)的疗效及并发症。方法:本研究为实验研究,采用非随机抽样的方法选取济宁医学院附属医院2019年1月至2022年1月收治的120例轻度NRDS患儿为研究对象,采用随机数字表法将患儿分为2组,HHHFNC组(60例)采用HHHFNC治疗,经鼻持续气道正压通气(NCPAP)组(60例)采用NCPAP治疗。收集2组患儿的一般资料(性别、胎龄、生后小时龄、出生体重和胸片分级),辅助通气治疗前和治疗24 h后的血气指标[动脉血氧饱和度(SaO_(2))、动脉血氧分压(PaO_(2))和动脉血二氧化碳分压(PaCO_(2))],临床指标(总住院时间、氧疗时间、总辅助通气时间、开奶时间和建立全肠道喂养时间),并发症发生情况(鼻损伤、腹胀或肺气漏)。采用《新生儿疼痛与不适量表》(EDIN量表)评价患儿的舒适度。评估辅助通气治疗(HHHFNC或NCPAP)的疗效。结果:HHHFNC组男36例,女24例,胎龄(28.46±1.12)周;NCPAP组男34例,女26例,胎龄(28.52±1.10)周。2组患儿性别、胎龄、生后小时龄、出生体重和胸片分级比较差异均无统计学意义(均P>0.05)。辅助通气治疗前2组患儿SaO_(2)、PaO_(2)、PaCO_(2)比较差异均无统计学意义(均P>0.05),治疗24 h后HHHFNC组SaO_(2)、PaO_(2)均高于NCPAP组,而PaCO_(2)低于NCPAP组[(90.32±4.22)%比(82.76±3.68)%,(66.35±5.64)mmHg比(55.64±5.50)mmHg(1 mmHg=0.133 kPa),(40.15±5.22)mmHg比(46.24±5.19)mmHg,均P<0.001]。治疗24 h后HHHFNC组和NCPAP组SaO_(2)、PaO_(2)较治疗前均升高,而PaCO_(2)较治疗前均降低(均P<0.05)。HHHFNC组总住院时间、氧疗时间、开奶时间、建立全肠道喂养时间均短于NCPAP组[(23.51±5.79)d比(28.22±6.27)d,(10.15±1.16)d比(12.25±1.25)d,(30.21±3.46)h比(36.05±3.72)h,(12.36±1.33)d比(18.05±2.06)d,均P<0.001],2组患儿总辅助通气时间比较差异无统计学意义(P>0.05)。HHHFNC组鼻损伤发生率和并发症总发生率均低于NObjective To observe the efficacy and complications of heated humidified high flow nasal cannula(HHHFNC)therapy for mild neonatal respiratory distress syndrome(NRDS).Methods This was an experimental study involving 120 children with mild NRDS admitted to the Affiliated Hospital of Jining Medical University from January 2019 to January 2022 selected by non-random sampling method.They were randomly assigned into HHHFNC group(60 cases,treated with HHHFNC)and nasal continuous positive airway pressure(NCPAP)group(60 cases,treated with NCPAP)by random number table method.General data(gender,gestational age,postnatal age in hours,birth weight and chest radiographic grade),blood gas indicators before and 24 hours after assisted ventilation(arterial oxygen saturation[SaO_(2)],arterial partial pressure of oxygen[PaO_(2)]and arterial partial pressure of carbon dioxide[PaCO_(2)]),clinical indicators(length of stay,duration for oxygen therapy,total assisted ventilation time,breastfeeding time and whole-intestinal feeding time),and complications(nasal injury,abdominal distension or pulmonary air leakage)were compared.The comfort level of the children was assessed using the EDIN scale(Échelle Douleur Inconfort Nouveau-Né,neonatal pain and discomfort scale).The efficacy of assisted ventilation therapy(HHHFNC or NCPAP)was assessed.Results There were 36 males and 24 females in the HHHFNC group,with a gestational age of(28.46±1.12)weeks.There were 34 males and 26 females in the NCPAP group,with a gestational age of(28.52±1.10)weeks.There were no significant differences in the gender,gestational age,postnatal age in hours,birth weight and chest radiographic grade between groups(all P>0.05).There were no significant differences in SaO_(2),PaO_(2) and PaCO_(2) between the two groups before assisted ventilation treatment(all P>0.05).After 24 h of treatment,SaO_(2)([90.32±4.22]%vs[82.76±3.68]%)and PaO_(2)([66.35±5.64]mmHg vs[55.64±5.50]mmHg,1 mmHg=0.133 kPa)in the HHHFNC group were significantly higher than those of the NCPAP gr

关 键 词：呼吸窘迫综合征 新生儿 加温湿化经鼻导管高流量通气 连续气道正压通气 治疗结果 并发症 

分 类 号：R722.12[医药卫生—儿科]