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目的探讨高流量鼻导管湿化氧疗(HHFNC)在新生儿肺炎并呼吸衰竭中的临床应用效果。方法回顾性分析2012年1月至2013年10月我院新生儿科收治、未达到机械通气指征的新生儿肺炎并呼吸衰竭患儿。根据治疗方法分为HHFNC组、普通吸氧组(对照组)和经鼻持续气道正压通气(CPAP)组。比较各组治疗效果,治疗前、治疗后12 h、24 h PaO2、PaO2/FiO2、呼吸频率等指标,以及患儿主要症状体征消失时间和住院时间。结果 HHFNC组(32例)治疗有效率高于对照组(25例)(87.5%比56.0%,P<0.05),与CPAP组(36例)相近(81.5%比91.1%,P>0.05);HHFNC组和CPAP组治疗后气促、三凹征、肺部啰音消失的时间及平均住院天数较对照组明显缩短(P<0.01),HHFNC组和CPAP组差异无统计学意义(P>0.05);HHFNC组治疗12 h、24 h后PaO2、PaO2/FiO2升高,呼吸频率减慢,与对照组比较差异有统计学意义(P<0.05),与CPAP组比较差异无统计学意义(P>0.05)。结论 HHFNC治疗新生儿肺炎并呼吸衰竭有显著疗效,损伤小,是一种适宜的新生儿无创呼吸支持技术。
Objective To investigate the clinical effect of high-flow nasal catheter humidification oxygen therapy (HHFNC) in neonatal pneumonia and respiratory failure. Methods From January 2012 to October 2013, neonates with neonatal pneumonia and respiratory failure who were admitted to neonatology department of our hospital and did not reach the indication of mechanical ventilation were retrospectively analyzed. According to the treatment method, the patients were divided into HHFNC group, normal oxygen inhalation group (control group) and nasal continuous positive airway pressure (CPAP) group. The therapeutic effects of each group were compared before treatment, 12 h after treatment, 24 h PaO2, PaO2 / FiO2, respiratory rate and other indicators, as well as the disappearance time and hospital stay of the main symptoms and signs in children. Results The effective rate of HHFNC group was higher than that of control group (25 cases) (87.5% vs. 56.0%, P <0.05), similar to that of CPAP group (36 cases) (81.5% vs 91.1%, P> 0.05). After HHFNC and CPAP treatment, the duration of the disappearance and the length of hospital stay were significantly shorter than those of the control group (P <0.01). There was no significant difference between HHFNC group and CPAP group (P> 0.05 ). The PaO2 and PaO2 / FiO2 increased and the respiratory rate slowed at 12 h and 24 h after HHFNC treatment (P <0.05), but there was no significant difference between the HHFNC group and the CPAP group (P > 0.05). Conclusion HHFNC treatment of neonatal pneumonia and respiratory failure have a significant effect, less damage, is a suitable neonatal noninvasive respiratory support technology.