经鼻导管高流量加温湿化正压通气治疗新生儿呼吸窘迫综合征的临床疗效观察

摘要

目的：观察经鼻导管高流量加温湿化正压通气（HHFNC）治疗新生儿呼吸窘迫综合征（NRDS）的临床疗效。方法选取黄冈市中心医院2014年4月—2015年4月收治的 NRDS 患儿61例，按照就诊时间分为对照组30例与观察组31例。两组患儿均给予猪肺磷脂注射液治疗，对照组患儿在此基础上给予经鼻持续气道正压通气（NCpAp）治疗，观察组患儿在此基础上给予 HHFNC 治疗。比较两组患儿治疗前及治疗12 h、24 h、72 h 动脉血氧分压（paO2）、动脉血二氧化碳分压（paCO2）、血氧饱和度（SaO2）和氧合指数，氧疗时间、住院时间、开始母乳喂养时间及治疗期间并发症发生率。结果两组患儿治疗前及治疗12 h、24 h、72 h paO2和 paCO2比较，差异无统计学意义（P >0.05）；治疗12 h、24 h、72 h 两组患儿 paO2均高于治疗前，paCO2均低于治疗前（P <0.05）。两组患儿治疗前 SaO2及氧合指数比较，差异无统计学意义（P >0.05）；观察组患儿治疗12 h、24 h、72 h SaO2及氧合指数均高于对照组（P <0.05）；治疗12 h、24 h、72 h 两组患儿 SaO2和氧合指数均高于治疗前（P <0.05）。观察组患儿氧疗时间、住院时间及开始母乳喂养时间均短于对照组（ P <0.05）。观察组患儿并发症发生率为9.6%，低于对照组的33.3%（P <0.05）。结论 HHFNC 治疗 NRDS 患儿的临床疗效确切，能有效改善患儿氧合状态，缩短氧疗时间、住院时间及开始母乳喂养时间，降低并发症发生率。%Objective To explore the clinical effect of heating and humidifying high - flow positive pressure ventilation through nasal catheter on neonatal respiratory distress syndrome. Methods A total of 61 newborns with neonatal respiratory distress syndrome were selected in the Central Hospital of Huanggang from April 2014 to April 2015,and they were divided into control group( n = 30 ) and observation group( n = 31 ) according to visiting sequence. Based on pig lung phospholipids injection,newborns of control group were given extra nasal continuous positive airway pressure ventilation,while newborns of observation group were given extra heating and humidifying high - flow positive pressure ventilation through nasal catheter. paO2 ,paCO2 ,SaO2 and paO2 / FiO2 before treatment and after 12 hours,24 hours,72 hours of treatment,duration of oxygen therapy,hospital stays,time to start breastfeeding and incidence of complications during treatment were compared between the two groups. Results No statistically significant differences of paO2 or paCO2 was found between the two groups before treatment or after 12 hours,24 hours,72 hours of treatment( P > 0. 05);paO2 of of both groups after 12 hours,24 hours,72 hours of treatment was statistically significantly higher than that before treatment,respectively,while SaO2 and paCO2 both groups after 12 hours,24 hours,72 hours of treatment was statistically significantly lower than that before treatment, respectively(P < 0. 05). No statistically significant differences of SaO2 or paO2 / FiO2 was found between the two groups before treatment(P > 0. 05),while paO2 / FiO2 of observation group were statistically significantly higher than those of control group after 12 hours,24 hours,72 hours of treatment(P < 0. 05);SaO2 and paO2 / FiO2 of both groups after 12 hours,24 hours,72 hours of treatment were statistically significantly higher than those before treatment( P < 0. 05). Duration of oxygen therapy, hospital stays and time to start breastfeeding of observation group were statistically significantly shorter than those of control group (P < 0. 05). The incidence of complications of observation group was 9. 6% during treatment,was statistically significantly lower than that of control group of 33. 3% ( P < 0. 05). Conclusion Heating and humidifying high - flow positive pressure ventilation through nasal catheter has certain clinical effect in treating neonatal respiratory distress syndrome,can effectively improve the oxygenation state,shorten the duration of oxygen therapy,hospital stays and time to start breastfeeding,reduce the incidence of complications.