摘要
目的探讨经鼻无创高频振荡通气(NHFOV),在呼吸窘迫综合征(RDS)极低出生体重早产儿初始呼吸支持治疗的临床疗效。方法选择2018年2月至2020年4月,于徐州市中心医院新生儿重症监护病房(NICU)治疗的92例RDS极低出生体重早产儿为研究对象。采用随机数字表法,将其分为NHFOV组(n=48,采取NHFOV治疗)及经鼻持续气道正压通气(NCPAP)组(n=44,采取NCPAP治疗)。对2组RDS极低出生体重早产儿一般临床资料,无创通气治疗前、后动脉血气分析指标,疗效,呼吸支持治疗相关并发症发生率及患儿死亡率,采用成组t检验、χ^(2)检验及Mann-Whitney U检验进行统计学比较。本研究经徐州市中心医院医学伦理委员会审核批准(审批文号:XZXY-LJ-20170328-006),并且与患儿监护人均签署临床研究知情同意书。结果①一般临床资料比较:2组RDS极低出生体重早产儿的性别、出生胎龄与体重及生后1、5 min Apgar评分,入院日龄及分娩前24 h母亲糖皮质激素使用率等一般临床资料比较,差异均无统计学意义(P>0.05)。②2组RDS极低出生体重早产儿动脉血气分析指标组间比较:NHFOV组RDS极低出生体重早产儿无创通气治疗后1 h、24 h动脉血二氧化碳分压(PaCO2)分别为(45.8±6.5)mmHg(1 mmHg=0.133 kPa)及(40.8±4.7)mmHg,均显著低于NCPAP组的(49.3±5.7)mmHg及(44.2±5.2)mmHg;治疗后1 h、24 h动脉血氧分压(PaO2)与吸入氧浓度分数(FiO2)比值(P/F)分别为(198.8±30.5)mmHg及(215.1±32.1)mmHg,均显著高于NCPAP组的(176.4±28.1)mmHg及(190.0±29.7)mmHg,并且上述差异均有统计学意义(t=2.809、3.301、3.663、3.881,P=0.003、<0.001、<0.001、<0.001)。③2组动脉血气分析指标分别进行组内比较均为:无创通气治疗后24 h的pH值及治疗后1、24 h的PaCO2水平,均较治疗前改善,而且治疗后24 h的P/F值高于治疗后1 h,并且差异均有统计学意义(P<0.05)。④无创通气疗效比较:NHFOV组RDS极低出生体重早产儿无创通气治疗后,肺表面活性剂(PS)使用率及有创机械通气率(22.9%、6.3%),均显著低于NCPAP组(45.5%、20.5%),并且差异均有统计学意义(χ^(2)=5.219、4.084,P=0.022、0.043)。2组RDS极低出生体重早产儿无创通气时间、柠檬酸咖啡因使用率、频繁呼吸暂停发生率及总用氧时间比较,差异均无统计学意义(P>0.05)。⑤2组RDS极低出生体重早产儿鼻损伤、肺气漏、新生儿坏死性小肠结肠炎(NEC)、Ⅲ~Ⅳ级脑室内出血(IVH)、早产儿视网膜病(ROP)(≥Ⅱ期)及支气管肺发育不良(BPD)发生率,以及患儿死亡率比较,差异均无统计学意义(P>0.05)。结论与NCPAP比较,NHFOV用于RDS极低出生体重早产儿初始呼吸支持治疗,能改善氧合、减少二氧化碳(CO2)潴留、减少有创机械通气及PS使用,同时不增加呼吸支持治疗相关并发症发生。
Objective To explore the clinical efficacy of transnasal noninvasive high frequency oscillation ventilation(NHFOV)in initial respiratory support of very low birth weight premature infants with respiratory distress syndrome(RDS).Methods A total of 92 cases of very low birth weight premature infants with RDS in neonatal intensive care unit(NICU)of Xuzhou Central Hospital from February 2018 to April 2020 were selected as research subjects.Through random number table method,they were divided into NHFOV group(n=48,used NHFOV noninvasive ventilation mode)and nasal continuous positive airway pressure(NCPAP)group(n=44,used NCPAP noninvasive ventilation mode).Their general clinical data,arterial blood gas analysis indicators before and after noninvasive ventilation treatment,therapeutic effect of noninvasive ventilation,incidences of complications related to respiratory support treatment and mortality rate were compared between 2 groups of very low birth weight premature infants with RDS by independent-samples t test,chi-square test and Mann-Whitney U test.This study was approved by the Medical Ethics Committee of Xuzhou Central Hospital(Approval No.XZXY-LJ-20170328-006).And all the children′s guardians signed informed consents of this study.Results①Comparison results of general clinical data:there were no significant differences between two groups in terms of gender,gestational age,birth weight,Apgar scores at 1 min and 5 min after birth,age of admission and maternal glucocorticoid use rate 24 h before delivery(P>0.05).②Inter-group comparison:arterial blood gas analysis indexes of arterial partial pressure of carbon dioxide(PaCO2)at 1 h and 24 h after noninvasive ventilation treatment in NHFOV group were(45.8±6.5)mmHg(1 mmHg=0.133 kPa)and(40.8±4.7)mmHg,respectively,which were significantly lower than those of(49.3±5.7)mmHg and(44.2±5.2)mmHg in NCPAP group accordingly;and the ratio of arterial oxygen partial pressure(PaO2)to fraction of inspired oxygen(FiO2)(P/F)at 1 and 24 h after treatment were(198.8±30.5)mmHg and(215.1±32.1)mmHg in NHFOV group,respectively,which were significantly higher than those of(176.4±28.1)mmHg and(190.0±29.7)mmHg in NCPAP group,and all differences mentioned above were statistically significant(t=2.809,3.301,3.663,3.881;P=0.003,<0.001,<0.001,<0.001).③Intra-group comparison:arterial blood gas analysis indexes of pH value at 24 h and PaCO2 levels at 1 and 24 h after noninvasive ventilation were all better improved than those before treatment,and P/F value at 24 h after treatment was higher than that at 1 h after treatment(P<0.05).④Comparison results of therapeutic effects of noninvasive ventilation between two groups:treatment rate with pulmonary surfactant(PS)and treatment rate of invasive mechanical ventilation in NHFOV group(22.9%and 6.3%)were significantly lower than those in NCPAP group(45.5%and 20.5%)after noninvasive ventilation treatment,and their differences were statistically significant(χ^(2)=5.219,4.084;P=0.022,0.043).There were no significant differences of duration of noninvasive ventilation,treatment rate with caffeine citrate,incidence of frequent apnea and total treatment time of oxygen inhalation between two groups(P>0.05).⑤There were no significant differences in incidence of nasal injury,pulmonary air leakage,neonatal necrotic enterocolitis(NEC),gradeⅢ-Ⅳintraventricular hemorrhage(IVH),retinopathy of prematurity(ROP)(≥gradeⅡ),bronchopulmonary dysplasia(BPD),and mortality between two groups(P>0.05).Conclusions Compared with NCPAP in initial respiratory support treatment of very low birth weight premature infants with RDS,NHFOV can improve oxygenation,prevent carbon dioxide(CO2)retention,reduce the use of invasive mechanical ventilation and exogenous PS,and not increase the incidence of several complications related to respiratory support therapy.
作者
翟敬芳
吴杰斌
刘枭
金宝
王彦波
陈洋
王云
周广玲
周彬
Zhai Jingfang;Wu Jiebin;Liu Xiao;Jin bao;Wang Yanbo;Chen Yang;Wang Yun;Zhou Guangling;Zhou Bin(Department of Perinatal Medicine Center,Xuzhou Central Hospital·Xuzhou Clinical School of Xuzhou Medical University,Xuzhou 221009,Jiangsu Province,China;Department of Pediatrics,Xuzhou Central Hospital·Xuzhou Clinical School of Xuzhou Medical University,Xuzhou 221009,Jiangsu Province,China)
出处
《中华妇幼临床医学杂志（电子版）》
CAS
2021年第5期598-605,共8页
Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition)
基金
江苏省卫健委妇幼健康科研项目(F201942)
徐州市科学技术局重点研发计划项目(KC18185)。
关键词
持续气道正压通气
无创高频振荡通气
呼吸窘迫综合征
新生儿
肺表面活性剂
血气分析
婴儿
极低出生体重
婴儿
早产
Continuous positive airway pressure
Noninvasive high frequency oscillation ventilation
Respiratory distress syndrome,newborn
Pulmonary surfactant
Blood gas analysis
Infant,very low birth weight
Infant,premature
