加温湿化高流量鼻导管通气治疗轻中度新生儿呼吸窘迫综合征的临床研究  

Clinical Study on the Treatment of Mild-moderate Neonatal Respiratory Distress Syndrome by Heated Humidified High-flow Nasal Cannula

作　　者：刘荣添[1] 蔡运相 毛金梅 沈子璇 龙琦[1] 白玉新 LIU Rongtian;CAI Yunxiang;MAO Jinmei;SHEN Zixuan;LONG Qi;BAI Yuxin(The Second People's Hospital of Shenzhen,The First Affiliated Hospital of Shenzhen University,Guangdong shenzhen 518035)

机构地区：[1]深圳市第二人民医院深圳大学第一附属医院,广东深圳518035

出　　处：《深圳中西医结合杂志》2024年第19期1-5,共5页Shenzhen Journal of Integrated Traditional Chinese and Western Medicine

基　　金：深圳市第二人民医院临床研究项目(20223357028)。

摘　　要：目的:探讨加温湿化高流量鼻导管通气(HHHFNC)治疗轻中度新生儿呼吸窘迫综合征(RDS)的有效性和安全性。方法:选取2022年1月至2023年12月收住深圳市第二人民医院新生儿重症监护病房的93例轻中度RDS早产儿作为研究对象。按照随机数字表法分为HHHFNC组(47例)和经鼻持续气道正压通气(NCPAP)组(46例),比较两组患儿临床治疗效果、血气指标及并发症发生情况。结果:与NCPAP组相比,HHHFNC组患儿总氧疗时间及无创通气时间均有缩短,24 h内呼吸暂停次数减少,但差异无统计学意义(P>0.05);两组患儿72 h内机械通气率、住院时长及肺表面活性物质(PS)使用率比较,差异无统计学意义(P>0.05)。两组患儿治疗12 h后血气分析氢离子浓度指数(pH)、动脉氧分压(PaO_(2))、动脉二氧化碳分压(PaCO_(2))及乳酸(Lac)比较,差异均无统计学意义(P>0.05);两组患儿气漏综合症、脑室内出血(IVH)、支气管肺发育不良(BPD)、坏死性小肠结肠炎(NEC)、喂养不耐受(FI)、早发型败血症(EOS)、腹胀及肺出血发生率比较,差异均无统计学意义(P>0.05),HHHFNC组较NCPAP组鼻损伤发生率显著减少(6.38 % vs 26.09 %),差异有统计学意义(P<0.05)。结论:HHHFNC作为轻中度新生儿RDS初始无创呼吸支持模式与NCPAP临床疗效相当,未增加并发症的发生,可显著降低鼻损伤发生率。Objective To investigate the efficacy and safety of heated humidified high-flow nasal cannula (HHHFNC) for the treatment of mild-to-moderate neonatal respiratory distress syndrome (RDS).Methods A total of 93 premature infants with mild to moderate RDS admitted to the neonatal intensive care unit of the Second People's Hospital of Shenzhen from January 2022 to December 2023 were selected as the research objects.According to the random number table method,the patients were divided into HHHFNC group (47 cases) and nasal continuous positive airway pressure (NCPAP) group (46 cases),and the clinical treatment effects,blood gas indicators,and incidence of complications were compared between the two groups.Results Compared with the NCPAP group,the total oxygen therapy time and non-invasive ventilation time of preterm infants in HHHFNC group were shortened,and the number of apneas within 24 hours was reduced,but the difference was not statistically significant (P > 0.05).There was no significant differences in mechanical ventilation rate within 72 hours,hospitalization length and pulmonary surfactant (PS) usage rate between the two groups (P > 0.05).There was no significant differences in hydrogen ion concentration index (pH),arterial oxygen partial pressure (PaO_(2)),arterial carbon dioxide partial pressure (PaCO_(2)) and lactic acid (Lac) between the two groups after 12 hours of treatment (P > 0.05).There was no statistically significant difference in the incidence of air leakage syndrome,intraventricular hemorrhage (IVH),bronchopulmonal dysplasia (BPD),necrotizing enterocolitis (NEC),feeding intolerance (FI),early-onset sepsis (EOS),abdominal distension and pulmonary hemorrhage between the two groups (P > 0.05).The incidence of nasal injury in HHHFNC group was significantly lower than that in NCPAP group (6.38% vs 26.09%),and the difference was statistically significant (P < 0.05).Conclusion As an initial non-invasive respiratory support model for mild to moderate neonatal ARDS,HHHFNC has comparable clinical efficacy t

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：R722.12[医药卫生—儿科]