加温湿化高流量鼻导管通气在胎粪吸入综合征并肺动脉高压机械通气撤机中的应用研究

Application of humidified high-flow nasal cannula in neonates with meconium aspiration syndrome and pulmonary hypertension after extubation

摘要:

目的 比较湿化高流量鼻导管通气（HHFNC）和经鼻持续气道正压通气（NCPAP）两种无创通气模式在胎粪吸入综合征（MAS）并持续肺动脉高压（PPHN）患儿机械通气撤机中的应用，探讨HHFNC的临床价值。方法 选取78例胎粪吸入综合征合并持续肺动脉高压的患儿，机械通气撤机后随机分为HHFNC组和NCPAP组，分别行HHFNC和NCPAP呼吸支持，比较两组无创通气后的血气、无创通气时间、撤机失败率及鼻部损伤、腹胀和脑室内出血（IVH）等并发症发生情况的差异。结果 两组患儿的撤机失败率、应用NCPAP/HHFNC后1 h的PaO₂和PCO₂值、PaO₂/PaO₂、无创通气时间、达全肠道喂养时间、住院时间以及IVH发生率的差异均无统计学意义（P > 0.05）。HHFNC组鼻损伤发生率（5.0%）低于NCPAP组（31.6%），P < 0.05；腹胀发生率（7.5%）低于NCPAP组（34.2%），P < 0.05。结论 NCPAP和HHFNC均可在新生儿MAS并PPHN经机械通气撤机后序贯使用，具有确定的效果；但HHFNC更易使患儿耐受，副作用较少、安全性较高。

Abstract:

Objective To investigate the clinical value of humidified high-flow nasal cannula (HHFNC) as a respiratory support after extubation by comparing it with nasal continuous positive airway pressure (NCPAP) in neonates with meconium aspiration syndrome (MAS) and persistent pulmonary hypertension of the newborn (PPHN). Methods A total of 78 neonates with MAS and PPHN were randomly administered with HHFNC or NCPAP immediately after extubation. The following indices were compared between the two groups:blood gas parameters, duration of noninvasive ventilation, rate of extubation failure, and incidence of complications, such as nasal damage, abdominal distension, and intraventricular hemorrhage. Results There were no significant differences in the rate of extubation failure, PaO₂, PCO₂, and PaO₂/FiO₂ ratio at one hour after NCPAP or HHFNC, duration of noninvasive ventilation, time to full enteral feeding, length of hospital stay, and incidence of intraventricular hemorrhage between the two groups (P > 0.05). The HHFNC group had significantly lower incidence of nasal damage (5.0% vs 31.6%; P < 0.05) and incidence of abdominal distension (7.5% vs 34.2%; P < 0.05) than the NCPAP group. Conclusions Both NCPAP and HHFNC can be used as the sequential therapy for neonates with MSA and PPHN after extubation, and they both have a definite effect. As a new strategy of respiratory support, HHFNC is better tolerated, and has fewer side effects than NCPAP.