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

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。     

早产儿经鼻高流量氧疗安全性和有效性的系统评价和Meta分析

目的评价经鼻高流量氧疗(HFNC)用于早产儿的安全性和有效性。方法计算机检索中国知网、中国生物医学文献数据库、维普数据库、万方数据库、Medline、Embase、Web of Sience和the Cochrane Library,收集早产儿应用HFNC(HFNC组)和经鼻持续气道正压通气(NCPAP组)的RCT,检索时间为建库至2017年3月31日。主要结局指标:住院病死率和治疗失败需有创机械通气(气管插管)率;次要结局指标:支气管肺发育不良(BPD)、气漏、肺部感染和鼻部损伤的发生率,肺表面活性物质的应用率。结果 8篇文献1 604例患儿进入本文Meta分析,HFNC组799例,NCPAP组805例。8篇均报告了计算机随机序列产生,7篇采用分配隐藏,8篇文献均无失访、数据完整性好、研究结果无选择性报告,其他偏倚不清楚。两组病死率和气管插管率差异均无统计学意义。病死率行亚组分析,差异仍无统计学意义。气管插管率行亚组分析显示,体重均数≥1 500 g(OR=1.58,95%CI:1.11~2.26,P=0.01)和胎龄≥28周(OR=1.58,95%CI:1.13~2.22,P=0.008),NCPAP组气管插管率低于HFNC组。BPD、气漏、肺部感染发生率和肺表面活性物质应用率,两组差异无统计学意义。HFNC组鼻部损伤发生率低于NCPAP组(OR=-0.14,95%CI:-0.19~-0.09,P0.0001)。结论 HFNC应用于早产儿的疗效和安全性有待进一步证实,其鼻部损伤发生率低于NCPAP。     

儿童经鼻高流量氧疗呼吸支持早期失败的高危因素分析

目的 探讨急性呼吸功能不全患儿经鼻高流量氧疗（HFNC）早期失败的高危因素。方法 回顾性分析2018年1~6月入住儿童重症监护室的123例行HFNC呼吸支持的急性呼吸功能不全患儿的临床资料。将住院期间无需升级呼吸支持方式，且成功撤离HFNC的患儿归为HFNC成功组（69例）；其余患儿在住院期间需升级呼吸支持方式（54例），其中使用HFNC 48 h内升级呼吸支持方式的患儿归为HFNC早期失败组（46例）。采用多因素logistic回归分析评估分析HFNC早期失败的危险因素。结果 HFNC早期失败组罹患休克、脓毒症、颅内高压综合征或多器官功能障碍综合征的比例显著高于HFNC成功组（P < 0.05）。早期失败组实施呼吸支持前的格拉斯哥昏迷评分、pH值、氧合指数均显著低于HFNC成功组（P < 0.05），而小儿死亡风险评分（PRISM评分）、PaCO₂/PaO₂比值显著高于HFNC成功组（P < 0.05）。多因素logistic回归分析显示，PRISM评分 > 4.5分和PaCO₂/PaO₂比值 > 0.64是HFNC早期失败的独立危险因素（OR分别为5.535、9.089，P < 0.05）。结论 PRISM评分 > 4.5分或PaCO₂/PaO₂比值 > 0.64的急性呼吸功能不全患儿行HFNC早期失败的风险较高。     

A review of non-invasive ventilation support in neonates

Non-invasive ventilation (NIV) is a mode of respiratory support commonly used on the neonatal unit. Since the advent of NIV, it has evolved from being used as a mode of respiratory support to wean infants from mechanical ventilation (MV) to a primary mode of respiratory support. Newer methods of NIV support such as nasal bilevel positive airway pressure (BiPAP) and humidified high flow nasal cannula oxygen therapy (HHFNC) have emerged in attempts to reduce intubation rates and subsequent MV in preterm infants. There is ongoing debate about the role of nasal continuous positive airway pressure (NCPAP) in reducing ventilator induced lung injury, its timing and use as a primary mode of ventilation in the very low birth weight and extreme preterm infants.This review gives an overview of the current understanding and practices of the different modes of NIV in the neonatal unit.     

First-line treatment using high-flow nasal cannula for children with severe bronchiolitis: Applicability and risk factors for failure

Background

Viral bronchiolitis is the leading cause of hospitalization in children during the first 12 months of life. There is evidence to support the use of noninvasive ventilation in bronchiolitis. A recent respiratory management of bronchiolitis is the use of high-flow nasal cannula (HFNC) therapy. The primary objective of this study was to evaluate the use of HFNC as the first-line treatment for children with severe bronchiolitis and the secondary objective was to identify factors for HFNC therapy failure.

双水平正压通气和经鼻持续气道正压通气治疗早产儿呼吸窘迫综合征的疗效和并发症Meta分析

目的 采用Meta分析的方法评价双水平正压通气(BiPAP）和经鼻持续气道正压通气（NCPAP）治疗早产儿呼吸窘迫综合征（RDS）的疗效和安全性。方法 计算机检索PubMed、Sciverse、Cochrane图书馆、中国知网、中国生物医学文献数据库、维普数据库及万方数据库,收集BiPAP和NCPAP治疗早产儿RDS的RCT文献。2名研究者根据纳入和排除标准独立筛选文献,应用RevMan 5.2软件进行Meta分析,比较BiPAP和NCPAP的治疗失败率、氧合情况和并发症发生率。结果 9篇RCT文献进入Meta分析,共纳入571例患儿,BiPAP 组289例,NCPAP组282例。Meta分析结果提示,BiPAP组治疗失败率低于NCPAP组,OR=0.42 （95%CI：0.20~0.89）,按出生体重行亚组分析,极低出生体重儿（出生体重<1 500 g）的1篇文献两组治疗失败率差异无统计学意义,OR=1.49(95%CI:0.51~4.33）;BiPAP组较NCPAP组显著提高呼吸支持后12 h和24 h PaO2 ,MD分别为6.88 mmHg（95%CI：4.38~9.38)和6.36 mmHg(95%CI：4.80~7.92);显著降低呼吸支持后12 h和24 h PaCO2,MD分别为-5.00 mmHg（95%CI：-5.75~-4.25)和-5.39 mmHg (95%CI:-6.18~-4.61);两组病死率差异无统计学意义,OR=0.76（95%CI:0.34~1.69）。支气管肺发育不良、新生儿坏死性小肠结肠炎、脑室内出血、气胸、早产儿视网膜病变等并发症发生率BiPAP和NCPAP组差异均无统计学意义。结论 BiPAP治疗早产儿RDS疗效优于NCPAP,且并发症发生率与NCPAP相当,但BiPAP治疗极低出生体重儿的疗效仍需积累更多证据。     

Humidified high flow nasal cannulae: current practice in Australasian nurseries, a survey

Aim: Humidified High Flow Nasal Cannula (HHFNC) has been increasingly adopted as a new means of respiratory support throughout the world. However, evidence to support its safety and efficacy is limited. The aim of the present survey was to determine current practices regarding the usage of HHFNC by neonatologists in Australia and New Zealand. Methods: Surveys were sent to all 167 neonatologists identified by the list of centres in the Australia and New Zealand Neonatal Network. Results: A total of 157 surveys were sent to valid email addresses: 111 (71%) responded of which 105 (67%) had completed the questionnaire. HHFNC is used in 17 (63%) of neonatal intensive care units in Australia and New Zealand. It is most commonly used to reduce nasal trauma (91%) and provide continuous positive airways pressure (62%). The main perceived benefits of HHFNC were the easier application and care of the infant (86%), and improved tolerance by the baby (84%). Rain out leading to fluid instillation into the upper airway (59%) was the most common problem. Conclusion: This survey has provided a snapshot of the practice of HHFNC usage in Australia and New Zealand in 2010 and has revealed that HHFNC use is widespread and that clinical practices are diverse. The majority of neonatologists acknowledge that there is limited evidence to support its efficacy and safety, and would be happy to participate in clinical trials to address how best to deliver HHFNC.     

高流量鼻导管吸氧对比经鼻持续气道正压通气治疗新生儿呼吸窘迫综合征疗效的Meta分析

目的 系统评价高流量鼻导管吸氧（HFNC）对比经鼻持续气道正压通气（nCPAP）治疗新生儿呼吸窘迫综合征（RDS）的有效性和安全性。方法 计算机检索PubMed、Embase、Cochrane Library、Web of Science、中国生物医学文献数据库、万方数据库、中国知网和维普数据库建库至2020年4月1日的文献,收集HFNC对比nCPAP运用于新生儿RDS的随机对照试验（RCT）。采用RevMan5.3软件对符合纳入标准的临床研究进行Meta分析。结果 共纳入12篇RCT文献,包括2 861例新生儿,其中胎龄≥28周2 698例（94.30%）, < 28周163例（5.70%）。在初始呼吸支持中,HFNC组治疗失败率高于nCPAP组（RR=1.86,95% CI：1.53~2.25,P < 0.001）;两组有创机械通气率（P=0.40）、肺表面活性物质使用率（P=0.77）的比较差异无统计学意义。在拔管后呼吸支持中,两组治疗失败率、重新插管率、总用氧时间的比较差异均无统计学意义（P > 0.05）。在初始呼吸支持和拔管后呼吸支持中,HFNC组的鼻损伤发生率均明显低于nCPAP组（P < 0.001）;HFNC组和nCPAP组病死率及气漏综合征、支气管肺发育不良、坏死性小肠结肠炎等并发症的发生率的比较差异均无统计学意义（P > 0.05）。结论 基于现有临床证据,HFNC作为新生儿RDS初始治疗时失败率高于nCPAP,不建议在新生儿RDS初始治疗时使用;在胎龄≥28周RDS新生儿撤机阶段可以考虑使用HFNC作为拔管后辅助呼吸支持。     

湿化高流量鼻导管通气治疗早产儿严重呼吸暂停

目的 探讨湿化高流量鼻导管通气（humidified high flow nasal cannula,HHFNC）治疗早产儿严重呼吸暂停的疗效.方法 选取82例短时间呼吸暂停2次以上（使用氨茶碱）,6h内反复发生,或需要面罩复苏囊正压通气的早产儿为研究对象,将患儿分为HHFNC组40例及经鼻持续气道正压通气（nasal continuous positive airway pressure,NCPAP）组42例,HHFNC组在此基础上应用HHFNC辅助治疗,NCPAP组应用NCPAP辅助治疗.治疗后观察两组患儿治疗总有效率、有创通气例数、无创通气时间、总用氧时间、氧交换指标及并发症发生情况.结果 HHFNC组治疗总有效率、有创通气例数、无创通气时间、氧交换指标、总用氧时间与NCPAP组比较,差异无统计学意义（P＞0.05）.HHFNC组鼻损伤并发率低于NCPAP组[10.0％ （4/40） vs 30.9％ （13/42）],差异有统计学意义（P＜0.05）;两组患儿并发坏死性小肠结肠炎、喂养不耐受、呼吸道感染、晶体后纤维化、支气管肺发育不良的并发率差异无统计学意义（P＞0.05）.结论 HHFNC治疗呼吸暂停作用与NCPAP相当,并能降低患儿鼻损伤的发生率,可应用于临床.     

High-flow nasal cannulae and nasal continuous positive airway pressure use in non-tertiary special care nurseries in Australia and New Zealand

Aim: Non‐tertiary centres (NTCs) in Australia and New Zealand are increasingly providing non‐invasive respiratory support, including high‐flow nasal cannulae (HFNC) and nasal continuous positive airway pressure (nCPAP), to newborn infants. We aimed to determine the proportion of NTCs in these countries treating newborn infants with HFNC and nCPAP, and how these therapies are used. Methods: We surveyed public and private NTCs in Australia and public NTCs in New Zealand. The survey, directed at senior medical and nursing staff, consisted of questions regarding unit demographics, HFNC and nCPAP use. Results: One hundred seventeen responses were received regarding HFNC use, from 88% (80/91) of public hospitals and 64% (37/58) of private hospitals surveyed. Ten (8.5%) responders (nine public and one private) used HFNC; all used the Fisher & Paykel system. HFNC was used for respiratory distress syndrome from birth (9/10 units), as a weaning mode from nCPAP (5/10 units) and as treatment for apnoea (3/10 units). Flow rates used ranged from 1 to 8 L/min, with typical minimum flow of 1 L/min and maximum of 4–6 L/min. The main perceived advantage of HFNC was ‘ease of use’. In the units treating newborn infants with nCPAP, it was used either in an ongoing fashion (43 units), short term or episodically (four units), or only for stabilisation prior to transfer (11 units). Excluding those units using nCPAP only for stabilisation and non‐responders, 47/108 (44%) units were using nCPAP. Conclusions: HFNC is being used in NTCs in Australia and New Zealand, and the use of nCPAP has increased over time.     

经鼻持续气道正压治疗新生儿呼吸衰竭

目的　探讨经鼻持续气道正压通气 ( NCPAP)治疗新生儿呼吸衰竭的疗效。 方法　 72例呼吸衰竭新生儿 ,其中 型呼衰 2 7例 , 型呼衰 45例 ,予 NCPAP治疗 ,观察患儿在 NCPAP前、NCPAP后 4～ 6 h、2 4h的临床及血气变化 ,比较 Pa O2 及Pa CO2 的变化。 结果　 70例病人 NCPAP后呼吸困难及缺氧征有不同程度好转 ,血气 Pa O2 明显提高 ( P<0 .0 5 ) ,Pa CO2 显著下降 ( P<0 .0 1)。 结论　 NCPA P可以改善氧合和通气 ,对 型、 型新生儿呼衰均有疗效     

Congenital dacryocystoceles controlled by nCPAP via nasal mask in a neonate

Congenital dacryocystocele is a relatively rare type of nasolacrimal duct obstruction that may induce respiratory distress during the early neonatal period. We encountered a case of bilateral congenital dacryocystoceles with intranasal cysts in a premature infant delivered at 34 weeks of gestation. The patient developed symptoms of respiratory failure immediately after birth, but no ophthalmologic symptoms. Treatment with nasal continuous positive airway pressure via a nasal mask, instead of a nasal prong, effectively relieved the symptoms. Early diagnosis and appropriate treatment are critical for infants with nasal obstruction.     

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目的评价经鼻间歇正压通气(NIPPV)与经鼻持续正压通气(NCPAP)治疗新生儿呼吸窘迫综合征(NRDS)的疗效。方法选择2010年1月至2011年11月入住河北省儿童医院新生儿重症监护室(NICU)的NRDS患儿66例,随机分为NIPPV组(32例)和NCPAP组(34例),分别于入院0、12、24、72h进行血气分析,比较氧合改善情况、氧疗时间、呼吸机使用时间及并发症和预后等。结果治疗开始时(入院0h)两组PaO2、PaCO2差异无统计学意义(P>0.05)。治疗12、24、72h后PaO2、PaCO2、P/F、a/APO2均有改善(P均<0.05),且NIPPV组改善情况优于NCPAP组,两组比较差异有统计学意义(P均<0.05)。两组患儿CO2潴留、腹胀发生率差异有统计学意义(P<0.05),且NIPPV组开奶时间较NCPAP组提前。NIPPV组经鼻通气治疗失败后改为插管行呼吸机通气率明显低于NCPAP组,差异有统计学意义(P<0.05)。结论 NIPPV较NCPAP能在短时间内明显改善肺部氧合功能,缩短无创辅助通气及氧疗时间,减少了CO2潴留、腹胀的发生率,且开奶时间提前,降低了气管插管呼吸机上机率。     

Use of high‐flow nasal cannula in neonates: Nationwide survey in Japan

High‐flow nasal cannula is a new modality of respiratory support and is increasing in popularity despite the lack of supporting evidence. We investigated the prevalence of its use in tertiary neonatal units in Japan. A paper‐based survey was conducted. The response rate was 83%. High‐flow nasal cannula was used in 46/80 units (58%), of which 96% used the high‐flow nasal cannula without guidelines. It was used for several indications, including weaning off nasal continuous positive airway pressure and post‐extubation respiratory support. The main perceived benefits of the cannula included better access to the neonate and reduced risk of nasal trauma. This survey found that high‐flow nasal cannula is used without clear criteria and that clinical practice varies across neonatal units in Japan. Its use in neonates needs to be urgently evaluated.