加温湿化高流量鼻导管吸氧在32周以下早产儿撤机中的疗效比较

Efficacy of heated humidified high-flow nasal cannula in preterm infants aged less than 32 weeks after ventilator weaning

摘要:

目的 观察26~31⁺⁶周呼吸窘迫综合征早产儿撤机后应用加温湿化高流量鼻导管吸氧(HHHFNC)和鼻塞持续气道正压(nCPAP)的疗效。方法 161例早产儿拔管后随机分成两组:治疗组接受HHHFNC治疗(n = 79);对照组接受nCPAP治疗(n = 82)。两组患儿又根据胎龄分为26~28⁺⁶周组和29~31⁺⁶周组。比较组间治疗失败率、拔管后7 d内再次插管率、并发症发生率和住院期间病死率。结果 治疗组和对照组两组早产儿治疗失败率和再插管率差异无统计学意义。胎龄26~28⁺⁶周的早产儿中,治疗组治疗失败率显著高于对照组 (P < 0.05),再次插管率差异无统计学意义;29~31⁺⁶周早产儿中,两组治疗失败率和再次插管率差异均无统计学意义。两组患儿并发症发生率和病死率差异亦无统计学意义。结论 对29~31⁺⁶周的早产儿撤机时应用HHHFNC能产生与nCPAP相似疗效,而对29周以下早产儿作为一线无创呼吸支持要谨慎。

Abstract:

Objective To investigate the efficacy of heated humidified high-flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (nCPAP) in preterm infants aged 26-31⁺⁶ weeks with respiratory distress syndrome after ventilator weaning. Methods A total of 161 preterm infants were randomly divided into two groups after ventilator weaning: HHHFNC treatment (n = 79) and nCPAP treatment (n = 82). The two groups were subdivided into 26-28⁺⁶ weeks and 29-31⁺⁶ weeks groups according to the gestational age. The treatment failure rate, reintubation rate within 7 days after extubation, incidence of complications, and mortality during hospitalization were compared between the two groups. Results The treatment failure rate and reintubation rate showed no significant differences between the HHHFNC and nCPAP groups. The preterm infants aged 26-28⁺⁶ weeks in the HHHFNC group had a significantly higher treatment failure rate than those in the nCPAP group (P < 0.05), while the reintubation rate showed no significant difference. As for the preterm infants aged 29-31⁺⁶ weeks, the treatment failure rate and reintubation rate showed no significant differences between the two groups. The incidence of complications and mortality showed no significant differences between the HHHFNC and nCPAP groups. Conclusions In preterm infants aged 29-31⁺⁶ weeks, HHHFNC has a similar efficacy as nCPAP after ventilator weaning, while in those aged less than 29 weeks, HHHFNC should be used with great caution if selected as the first-line noninvasive respiratory support.