湿化高流量鼻导管通气在早产儿机械通气撤机中的应用研究

目的探讨湿化高流量鼻导管通气（HHFNC）的应用效果和安全性。方法选择2012年1-12月本院新生儿重症监护中心收治的胎龄〈34周且出生体重〈1500 g的Ⅲ-Ⅳ级呼吸窘迫综合征（RDS）患儿,患儿撤机后随机分为HHFNC组和经鼻持续气道正压通气（NCPAP）组,比较两组患儿的鼻部损伤发生率、重新气管插管率、气漏及支气管肺发育不良发生率、病死率以及撤机时间、住院时间、呼吸机治疗费用等。结果和NCPAP组相比,HHFNC组鼻损伤较少[1/28（3.6%）比8/31（25.8%）,P〈0.05],呼吸机治疗费用也较低[（5.8±1.9）千元比（8.6±1.8）千元,P〈0.01]。两组患儿的病死率、重新插管率、应用NCPAP/HHFNC后1 h的PaO2和PCO2值、撤机时间、机械通气时间、住院时间以及气漏、支气管肺发育不良、坏死性小肠结肠炎、严重脑室内出血、早产儿视网膜病发生率等差异均无统计学意义（P〉0.05）。结论 HHFNC是一种容易被接受且效果良好的早产儿呼吸支持方式,其潜在优势包括简便、容易耐受、较少鼻部损伤、成本更低,更便于推广。

Application of humidified high flow nasal cannula for post-extubation support in preterm infants

Objective To investigate the safety and effectiveness of humidified high flow nasal cannula（HHFNC） for post-extubation support in preterm infants. Methods Preterm infants（gestational age less than 34 week and body weight less than 1500 g spelling to our NICU from Jan. 2012 to Oct. 2012 with the diagnosis of grade Ⅲ - Ⅳ respiratory distress syndrome （RDS） were recruited. They were randomly assigned to HHFNC group and NCPAP group. The incidence of nasal damage, re-intubation, air-leak, bronchi pulmonary dysphasia （ BPD ） and hospital stay and the cost for respiratory support death, along with mechanical ventilation duration, were compared between the two groups. Results Comparing with NCPAP group, the incidence of nasal damage was less in HHFNC group [ 1/28（3.6% ） vs. 8/31 （25.8%） ,P 〈0. 05]. And the cost for respiratory support was less in HHFNC group than that of the NCPAP group [ （ 5800 ± 1900 ） RMB vs. （ 8600 ± 1800 ） RMB, P 〈 0. 01 ]. No statistically significant differences existed between the two groups in death rate, re-intubation rate, PaO2 ＆ PCO2 level, weaning duration of mechanical ventilation, duration of mechanical ventilation, total hospital stay, air leak, BPD, NEC, severe IVH and ROP （P 〉 0.05）. Conclusions HHFNC is a very effective and well-tolerated strategy of respiratory support for preterm infants. It＇s easy to be accepted in variousclinical settings.