高流量鼻导管与持续气道正压通气治疗极低出生体质量儿的疗效分析

doi:10.6040/j.issn.1671-7554.0.2017.630

摘要/Abstract

摘要： 目的评价极低出生体质量儿生后早期应用高流量鼻导管通气的安全性及有效性。方法 106例28~32周符合纳入标准的极低出生体质量儿随机分为2组,一组给予高流量鼻导管通气(HHHFNC)治疗,另一组给予经鼻持续气道正压通气(NCPAP)治疗。主要评价指标为呼吸系统结局和并发症的发生率。结果共分析98例数据,HHHFNC组在鼻损伤发生率上较NCPAP组低(2.0% vs 14.6%,P=0.029),差异有统计学意义。两组在其他各项指标上差异均无统计学意义(P>0.05)。结论 28~32周胎龄极低出生体质量儿生后早期采用HHHFNC与NCPAP相比同样有效,但其安全性更好。

关键词: 高流量鼻导管通气, 经鼻持续气道正压通气, 无创通气, 极低出生体质量儿

Abstract: Objective To assess the efficacy and safety of humidified heated high flow nasal cannula(HHHFNC)compared with nasal continuous positive airway pressure(NCPAP)for the initial respiratory support of very low birth weight(VLBW)infants. Methods A total of 106 VLBW infants with gestational age(GA)between 28-32 weeks who met the predefined criteria for noninvasive ventilation were randomized to either the HHHFNC group or NCPAP group. The evaluation indexes included the respiratory outcomes and the incidence of complications. Results The clinical data of 98 infants were analyzed. The incidence of nasal trauma was significantly lower in the HHHFNC group than in the NCPAP group(2.0% vs 14.6%, P=0.029). There were no differences in the other respiratory and clinical outcomes between the two groups(P>0.05). Conclusion Compared to NCPAP, HHHFNC appears to be safer while has a similar efficacy as an initial respiratory support in VLBW infants with GA between 28-32 weeks.

Key words: High flow nasal cannula, Nasal continuous positive airway pressure, Noninvasive ventilation, Very low birth weight infants

中图分类号:

R722

姜春节,齐鲁,肖俊超,薛江. 高流量鼻导管与持续气道正压通气治疗极低出生体质量儿的疗效分析[J]. 山东大学学报 (医学版), 2018, 56(2): 18-22.

JIANG Chunjie, QI Lu, XIAO Junchao, XUE Jiang. Humidified heated high flow nasal cannula versus nasal continuous positive airway pressure for initial respiratory support of very low birth weight infants[J]. Journal of Shandong University (Health Sciences), 2018, 56(2): 18-22.

参考文献

[1] Botet F, Figueras-Aloy J, Miracle-Echegoyen X, et al. Trends in survival among extremely-low-birthweight infants(less than 1 000 g)without significant bronchopulmonary dysplasia[J]. BMC Pediatrics, 2012, 12: 63.
[2] Ali Z, Schmidt P, Dodd J, et al. Bronchopulmonary dysplasia: a review[J]. Arch Gynecol Obstet, 2013, 288(2): 325-333.
[3] SUPPORT Study Group of the Eunice Kennedy Shriver NICHD Neonatal Research Network, Finer NN, Carlo WA, et al. Early CPAP versus surfactant in extremely preterm infants[J]. N Engl J Med, 2010, 362(21): 1970-1979.
[4] Badiee Z, Naseri F, Sadeghnia A. Early versus delayed initiation of nasal continuous positive airway pressure for treatment of respiratory distress syndrome in premature newborns: A randomized clinical trial[J]. Adv Biomed Res, 2013, 2: 4. doi:10.4103/2277-9175.107965.
[5] Pfister RH, Soll RF. Initial respiratory support of preterm Infants-the role of CPAP, the INSURE method, and noninvasive ventilation[J]. Clin Perinatol, 2012, 39(3): 459-481.
[6] Schmölzer GM, Kumar M, Pichler G, et al. Non-invasive versus invasive respiratory support in preterm infants at birth: systematic review and meta-analysis[J]. BMJ, 2013, 347: f5980. doi:10.1136/bmj.f5980.
[7] Manley BJ, Dold SK, Davis PG, et al. High-flow nasal cannulae for respiratory support of preterm infants: a review of the evidence[J]. Neonatology, 2012, 102(4): 300-308.
[8] Wilkinson D, Andersen C, O'Donnell CP, et al. High flow nasal cannula for respiratory support in preterm infants [J]. Cochrane Database Syst Rev, 2016, 2: CD006405.
[9] Roehr CC, Yoder BA, Davis PG, et al. Evidence support and guidelines for using heated, humidified, high-flow nasal cannulae in neonatology oxford nasal high-flow therapy meeting, 2015 [J]. Clin Perinatol, 2016, 43(4): 693-705.
[10] Bhandari A, Bhandari V. Pitfalls, problems, and progress in bronchopulmonary dysplasia [J]. Pediatrics, 2009, 123(6): 1562-1573.
[11] Ni(~overn)o DF, Sodhi CP, Hackam DJ. Necrotizing enterocolitis: new insights into pathogenesis and mechanisms [J]. Nat Rev Gastroenterol Hepatol, 2016, 13(10): 590-600.
[12] 邵肖梅, 叶鸿瑁, 丘小汕. 实用新生儿学[M]. 4版. 北京: 人民卫生出版社, 2011: 707,889.
[13] Zhou JJ, Zhang P, Cheng GQ. Advance in researches on neonatal humidified high flow nasal cannulae [J]. Zhonghua Er Ke Za Zhi, 2013, 51(11): 871-873.
[14] Lavizzari A, Veneroni C, Colnaghi M, et al. Respiratory mechanics during NCPAP and HHHFNC at equal distending pressures[J]. Arch Dis Child Fetal Neonatal Ed, 2014, 99(4): F315-320.
[15] Shetty S, Hickey A, Rafferty GF, et al. Work of breathing during CPAP and heated humidified high-flow nasal cannula [J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(5): F404-407.
[16] de Waal CG, Hutten GJ, Kraaijenga JV, et al. Electrical activity of the diaphragm during nCPAP and high flow nasal cannula [J]. Arch Dis Child Fetal Neonatal Ed, 2017, 102(5): F434-F438.
[17] Shin J, Park K, Lee EH, et al. Humidified high flow nasal cannula versus nasal continuous positive airway pressure as an initial respiratory support in preterm infants with respiratory distress: a randomized, controlled non-inferiority trial [J]. J Korean Med Sci, 2017, 32(4): 650-655.
[18] Lampland AL, Plumm B, Meyers PA, et al. Observational study of humidified high-flow nasal cannula compared with nasal continuous positive airway pressure[J]. J Pediatr, 2009, 154(2): 177-182.
[19] Al-Alaiyan S, Dawoud M, Al-Hazzani F. Positive distending pressure produced by heated, humidified high flow nasal cannula as compared to nasal continuous positive airway pressure in premature infants[J]. J Neonatal Perinatal Med, 2014, 7(2): 119-124.
[20] Yoder BA, Stoddard RA, Li M, et al. Heated, humidified high-flow nasal cannula versus nasal CPAP for respiratory support in neonates[J]. Pediatrics, 2013, 131(5): e1482-1490.
[21] Taha DK, Kornhauser M, Greenspan JS, et al. High flow nasal cannula use is associated with increased morbidity and length of hospitalization in extremely low birth weight infants[J]. J Pediatr, 2016, 173: 50-55.e1. doi: 10.1016/j.jpeds.2016.02.051.
[22] Manley BJ, Owen LS, Doyle LW, et al. High-flow nasal cannulae in very preterm infants after extubation [J]. N Engl J Med, 2013, 369(15): 1425-1433.
[23] Nath P, Ponnusamy V, Willis K, et al. Current practices of high and low flow oxygen therapy and humidification in UK neonatal units[J]. Pediatr Int, 2010, 52(6): 893-894.
[24] Kotecha SJ, Adappa R, Gupta N, et al. Safety and efficacy of high-flow nasal cannula therapy in preterm infants: a meta-analysis[J]. Pediatrics, 2015, 136(3): 542-553.

多维度评价

Viewed

Full text

Abstract

Cited

Shared

Discussed