加温湿化高流量鼻导管通气初始治疗早产儿呼吸窘迫综合征疗效及对心功能的影响  

Efficacy and the Effects on Cardiac Function of HHHFNC as Initial Treatment for Preterm Infants with Neonatal Respiratory Distress Syndrome

作　　者：雷红林 施鸿珊 张崇巽 徐思媛 王冰洁 刘怡雯 孙中怡 李丽[1] 高翔羽[1] LEI Honglin;SHI Hongshan;ZHANG Chongxun(Department of Neonatology,Xuzhou Central Hospital(Xuzhou Clinical College of Xuzhou Medical University),Jiangsu 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)新生儿科,221009

出　　处：《医学研究杂志》2025年第3期114-119,共6页Journal of Medical Research

基　　金：江苏省卫生健康委员会科研项目(Z2020060);江苏省妇幼保健协会科研项目(FYX202109)。

摘　　要：目的比较加温湿化高流量鼻导管通气(heated humidified high-flow nasal cannula,HHHFNC)和经鼻持续气道正压通气(nasal continuous positive airway pressure,NCPAP)在早产儿呼吸窘迫综合征(neonatal respiratory distress syndrome,NRDS)初始治疗的疗效及对心功能的影响。方法选自徐州市中心医院2021年1月~2023年11月收治的胎龄<35周、需无创通气的早产儿NRDS进行前瞻性研究,随机分为HHHFNC组和NCPAP组,初始治疗分别采用HHHFNC和NCPAP。比较疗效、安全性及对心功能的影响。结果HHHFNC组55例,NCPAP组53例。两组给予肺表面活性剂的例数和总剂量、入组24h内呼吸暂停次数、无创通气时长、无创通气失败例数、达全肠道喂养时间、住院时长和住院费用等比较,差异均无统计学意义(P>0.05)。HHHFNC组鼻损伤率明显低于NCPAP组(0 vs 11.3%,P=0.032);两组气胸、Ⅱ~Ⅲ期坏死性小肠结肠炎、血流动力学显著异常动脉导管未闭、Ⅱ~Ⅳ级脑室内出血、支气管肺发育不良和首次筛查需要治疗的早产儿视网膜病等比较,差异均无统计学意义(P>0.05)。两组无创通气24±6h和48±6h、组间吸入氧浓度和动脉血二氧化碳分压比较,差异无统计学意义(P>0.05),组间血浆B型尿钠肽(183.9±48.5ng/L vs 187.8±51.4ng/L,189.4±50.9ng/L vs 180.2±45.1ng/L)和右室Tei指数(0.38±0.05 vs 0.40±0.06,0.38±0.06 vs 0.39±0.06)比较,差异无统计学意义(P>0.05)。结论在胎龄<35周、需要无创通气的NRDS早产儿初始治疗中,HHHFNC疗效与NCPAP相似,鼻损伤率更低。两者其他安全性指标及对心功能的影响相似。Objective To compare the efficacy and the effects on cardiac function of heated humidified high-flow nasal cannula(HHHFNC)and nasal continuous positive airway pressure(NCPAP)as initial treatment for preterm infants with neonatal respiratory distress syndrome(NRDS).Methods The preterm infants with NRDS,gestational age<35 weeks and requiring noninvasive ventilation admitted to Xuzhou Central Hospital from January 2021 to November 2023 were enrolled for a prospective study and were randomly divided into the HHHFNC group and NCPAP group.The initial treatment was performed using HHHFNC and NCPAP respectively.The efficacy,safety and effects on cardiac function were compared.Results 55 cases were enrolled in HHHFNC group,and 53 cases were enrolled in NCPAP group.There were no statistically significant difference between the two groups in the number and total dose of the use of pulmonary surfactant,the number of apneas within 24hours of enrollment,the duration of noninvasive ventilation,the cases of noninvasive ventilation failure,the age achieving total enteral nutrition,the length and costs of hospitalization(P>0.05).The incidence of nasal injury in the HHHFNC group was significantly lower than that in the NCPAP group(0 vs 11.3%,P=0.032).There were no statistically significant difference between the two groups in the pneumothorax,stageⅡ-Ⅲnecrotizing enterocolitis,hemodynamically significant patent ductus arteriosus,gradeⅡ-Ⅳintraventricular hemorrhage,bronchopulmonary dysplasia,and retinopathy of prematurity requiring treatment at the first screening(P>0.05).There were no statistically significant difference between the two groups in fraction of inspired oxygen and arterial partial pressure of carbon dioxide,Plasma B-type natriuretic peptide(183.9±48.5ng/L vs 187.8±51.4ng/L,189.4±50.9ng/L vs 180.2±45.1ng/L)and Tei index of right ventricle(0.38±0.05 vs 0.40±0.06,0.38±0.06 vs 0.39±0.06)at 24±6h and 48±6h after noninvasive ventilation(P>0.05).Conclusion In the initial treatment for preterm infants(gestati

关 键 词：无创通气 呼吸窘迫综合征 新生儿 尿钠肽 TEI指数 

分 类 号：R722[医药卫生—儿科]