目的 比较加热湿化经鼻高流量氧疗(HHFNC)与鼻导管持续正压通气(nCPAP)在婴幼儿中重度毛细支气管炎中疗效及安全性.方法 选取2016年9月至2017年5月在青岛大学附属医院儿童重症医学科住院、符合中重度毛细支气管炎诊断标准的32例患儿,随机分为HHFNC治疗组17例、nCPAP治疗组15例.比较2组患儿治疗12 h前后的心率、呼吸、氧饱和度(SpO2)及动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、pH值,无创通气时间、并发症、机械通气的发生.结果 HHFNC组治疗12 h后心率为(130.88±2.87)次/min、呼吸为(37.35 ±3.55)次/min、SpO2为(97.06±1.43)%,pa(O2)为(99.65±8.07) mmHg、pa(CO2)为(35.88±4.27)mmHg、pH值为7.42±0.03;nCPAP组治疗12 h后心率为(135.73±6.29)次/min、呼吸为(41.40 ±4.40)次/min、SpO2为(96.00±1.13)%,pa(O2)为(91.33 ±9.45) mmHg、pa(CO2)为(40.13±3.72) mmHg、pH为(7.39±0.03);2组在治疗后较治疗前各项指标改善明显,差异均有统计学意义(均P<0.05);HHFNC组治疗12 h后各项指标较nCPAP组改善明显,差异均有统计学意义(均P<0.05);HHFNC治疗组无创通气时间为(45.88 ±6.49)h,nCPAP治疗组无创通气时间为(49.33 ±8.99)h,2组间无创通气时间比较差异无统计学意义(t=1.254,P=0.219);其中nCPAP治疗组有12例(80.0%)出现轻度并发症,3例(20.0%)病情变化进行机械通气;而HHFNC治疗组仅有5例(29.4%)出现轻度并发症,1例(5.9%)患儿需机械通气.结论 HHFNC在婴幼儿中重度毛细支气管炎其疗效与安全性优于nCPAP,可显著缓解患儿临床表现.
Objective To compare the efficacy and safety of humidified high-flow nasal cannula (HHFNC)and nasal continuous positive airway pressure (nCPAP) for moderate and severe bronchiolitis treatment in infants.Methods Thirty-two infants who were diagnosed as moderate and severe bronchiolitis admitted to Department of Pediatric Critical Care Medicine,the Affiliated Hospital of Qingdao University from September 2016 to May 2017 were selected,and they were randomly assigned into HHFNC group(17 cases) and nCPAP group(15 cases).The heart rate,breathing,oxygen saturation (SpO2),arterial partial pressure of oxygen [Pa (O2)],partial pressure of carbon dioxide [Pa (CO2)],pH value after treatment for 12 h,the duration of non-invasive ventilation and the incidence rates of invasive ventilation use,complications were compared between the 2 groups.Results After the treatment for 12 h,in HHFNC group,the heart rate was (130.88 ± 2.87) times/min,respiratory rate was (37.35 ± 3.55) times/min,SpO2 was(97.06 ± 1.43)%,pa(O2) was (99.65-±8.07) mmHg,pa(CO2) was (35.88 ±4.27) mmHg,pH was 7.42 ± 0.03;while in the nCPAP group,the heart rate was (135.73 ± 6.29) times/min,respiratory rate was (41.40 ± 4.40)times/min,SpO2 was (96.00 ± 1.13) %,Pa (O2) was (91.33 ± 9.45) mmHg,pa (CO2) was (40.13 ± 3.72)mmHg,pH was 7.39 ± 0.03.The breathing,heart rate,oxygen saturation and arterial blood gas in both groups after treatment were improved significantly compared with those before treament,and the differences were statistically significant (all P < 0.05);after treatment for 12 h,the heart rate,breathing,oxygen saturation and arterial blood gas of HHFNC group were improved more than those of the nCPAP group,and the differences had statistical significance (all P < 0.05).The duration of non-invasive ventilation was (45.88-± 6.49) hours in HHFNC group,and (49.33 ± 8.99) hours in nCPAP group,so there was no difference between the 2 groups (t =1.254,P =0.219).There was 12 cases (80.0%) of mild complication in nCPAP group and 5 cases(29.4%) in HHFNC group,while the incidence rate of invasive ventilation use was 3 cases(20.0%) in nCPAP group and 1 case (5.9%) in HHFNC group.Conclusion The efficacy and security of HHFNC on moderate and severe bronchiolitis are better than those of nCPAP,and it is recommended for clinical application widely.