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.

Effect of humidified high flow nasal cannula on severe apnea in preterm infants

Objective To investigate the effect of humidified high flow nasal cannula （HHFNC） on severe apnea in preterm infants.Methods Eighty-two preterm infants who developed apnea more than twice in short time,recurred within 6 hours or needed mask respirator were divided into HHFNC group（n =40） and nasal continuous positive airway pressure（NCPAP） group （n =42）.Both groups were given aminophylline intravenously.The total therapeutic effect rate,the number of cases who needed mechanical ventilation during the observation period,the duration of non-invasive ventilation,the duration of oxygen therapy,the oxygen exchange indexes and the complications of two groups were observed.Results There were no significant differences between two groups in the therapeutic effect rate,the number of cases who need invasive ventilation,the duration of non-invasive ventilation time,oxygen exchange indexes and the duration of oxygen usage （P 〉 0.05）.The numbers of nose injury of HHFNC group were less than those of the NCPAP group 10.0% （4/40） vs.30.9% （13/42）] （P 〈0.05）.No significant differences were found between two groups in the complication of necrotizing enterocolitis or feeding intolerance,respiratory infection,retinopathy of prematurity,bronchopulmonary dysplasia （P 〈 0.05）.Conclusion HHFNC has the same effect as NCPAP in the treatment of severe apnea in preterm infants except for lower prevalence of nose injury.