两种鼻塞用于经鼻间歇正压通气初始治疗新生儿呼吸窘迫综合征的比较

Comparison of the application of two kinds of nasal plugs in NIPPV as initial treatment for neonatal respiratory distress syndrome

摘要

目的 比较两种鼻塞应用于经鼻间歇正压通气(NIPPV)初始治疗新生儿呼吸窘迫综合征(NRDS)的价值。方法 采取前瞻性随机对照研究方法,选取本院160例初始治疗NRDS患儿,按照随机数字表法分为两组,普通无创鼻塞组选择普通无创通气鼻塞用于NIPPV,高流量通气鼻塞组选择高流量通气鼻塞用于NIPPV,比较两组治疗前与治疗2h后二氧化碳分压(PaCO₂)、3d内气管插管率和肺表面活性物质(PS)使用率、7d内气管插管率、治疗时间指标(总辅助通气时间、无创辅助通气时间、有创辅助通气时间、总用氧时间)、并发症发生情况。结果 高流量通气鼻塞组患儿治疗2h后PaCO₂显著低于普通无创鼻塞组(t=2.776,P=0.006);两组3d内气管插管率和PS使用率、7d内气管插管率比较无显著差异(P>0.05);高流量通气鼻塞组总辅助通气时间(t=6.084,P<0.001)、无创辅助通气时间(t=6.205,P<0.001)、总用氧时间(t=6.060,P<0.001)及有创辅助通气时间(t=3.665,P=0.002)显著短于普通无创鼻塞组;两组气漏、颅内出血、坏死性小肠结肠炎、早产儿视网膜病、动脉导管未闭、支气管肺发育不良发生率比较无显著差异(P>0.05);高流量通气鼻塞组鼻损伤发生率显著低于普通无创鼻塞组(χ²=21.560,P<0.001)。结论 与普通无创通气鼻塞相比,高流量通气鼻塞用于经鼻间歇正压通气初始治疗新生儿呼吸窘迫综合征能够促进患儿PaCO₂恢复,缩短辅助通气时间,降低鼻损伤发生风险.

Abstract

Objective To compare the value of two types of nasal prongs in the initial treatment of neonatal respiratory distress syndrome (NRDS) with nasal intermittent positive pressure ventilation (NIPPV). Methods A prospective randomized controlled trial was conducted among 160 infants with NRDS who received initial treatment in our hospital. According to a random number table, patients were divided into two groups: the conventional non-invasive nasal prong group, in which conventional non-invasive nasal prongs were used for NIPPV, and the high-flow nasal prong group, in which high-flow nasal prongs were used for NIPPV. The two groups were compared in terms of partial pressure of carbon dioxide (PaCO₂) before treatment and 2 hours after treatment, intubation rate and pulmonary surfactant (PS) usage within 3 days, intubation rate within 7 days, treatment time indicators (total duration of assisted ventilation, duration of non-invasive assisted ventilation, duration of invasive assisted ventilation, and total oxygen therapy time), and incidence of complications. Results After 2 hours of treatment, PaCO₂ was significantly lower in the high-flow nasal prong group than in the conventional non-invasive nasal prong group (t=2.776, P=0.006). There were no significant differences between the groups in the intubation rate or PS usage within 3 days, or the intubation rate within 7 days (P>0.05). Compared with the conventional nasal prong group, the high-flow nasal prong group showed significantly shorter total assisted ventilation time (t=6.084, P<0.001), non-invasive assisted ventilation time (t=6.205, P<0.001), total oxygen therapy time (t=6.060, P<0.001), and invasive assisted ventilation time (t=3.665, P=0.002). No significant differences were found between the two groups in the incidence of air leak, intracranial hemorrhage, necrotizing enterocolitis, retinopathy of prematurity, patent ductus arteriosus, or bronchopulmonary dysplasia (P>0.05). However, the incidence of nasal injury was significantly lower in the high-flow nasal prong group than in the conventional nasal prong group (χ²=21.560, P<0.001). Conclusion Compared with conventional non-invasive nasal prongs, high-flow nasal prongs used for NIPPV in the initial treatment of NRDS can promote the recovery of PaCO₂, shorten the duration of assisted ventilation, and reduce the risk of nasal injury.

关键词

新生儿呼吸窘迫综合征 / 经鼻间歇正压通气 / 高流量通气鼻塞 / 无创通气鼻塞

Key words

neonatal respiratory distress syndrome / nasal intermittent positive pressure ventilation / high-flow nasal plug / non-invasive nasal plug

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基金资助

深圳市龙岗区医疗卫生科技项目(非扶持类)(LGWJ2022G62)