Wang C H, Shi L P, Ma X L, Lin H J, Xu Y P, Du L Z
Department of Neonatal Intensive Care Unit, Children's Hospital, Zhejiang University School of Medicine, Hangzhou 310051, China.
Zhonghua Er Ke Za Zhi. 2017 Mar 2;55(3):177-181. doi: 10.3760/cma.j.issn.0578-1310.2017.03.003.
To evaluate the effectiveness and safety of the use of noninvasive high-frequency oscillation ventilation (nHFOV) in very low birth weight infants. A total of 36 cases received nHFOV between January 2016 and October 2016 in Children's Hospital, Zhejiang University School of Medicine, including 24 males and 12 females, with the gestational age of (27.5±2.5) weeks and birth weight of(980±318)g. The data of the ventilator settings, side effects, and changes of the respiratory function before and after nHFOV were collected and analyzed retrospectively. Nonparametric tests or tests or χ(2) tests were used. Thirty-two (89%) out of the 36 cases successfully avoided intubation or re-intubation after using of nHFOV. nHFOV was used as the rescue treatment after failure of other noninvasive ventilation in 17 cases, and as the prophylactical treatment preventing re-intubation after extubation in the remaining 19 cases. There were significant decreases in the incidences of apnea and desaturation(SpO(2)<0.85), the level of PaCO(2, )and the FiO(2) 24 h after the initiation of the nHFOV as the rescue therapy((1.2±1.1).(6.3±2.1)episodes , (1.1±1.2) .(4.3±1.5) episodes, (43±8) .(56±10) mmHg, 0.30±0.07 . 0.39±0.11, respectively; 1 mmHg=0.133 kPa, =7.562, 8.913, 4.179, 3.437 respectively, all <0.01). No significant changes were found in FiO(2) and PaCO(2) levels 24 h after initiation of nHFOV as the prophylactical therapy after extubation (0.42±0.12 .0.40±0.10, (49±8).(48±7)mmHg, =0.872 and 0.501 respectively, both >0.05), except for the significant decreases in the mean airway pressure ((7.9±2.6).(9.6±1.6)cmH(2)O, 1 cmH(2)0=0.098 kPa, =2.198, =0.041). There were 4 cases suffered from nasal septum injury, while no other nHFOV related complications were noted. nHFOV can be applied in preterm infants as a rescue treatment after the failure of other noninvasive ventilation, or prophylactically used in patients who have high risk of re-intubation.
评估无创高频振荡通气（nHFOV）在极低出生体重儿中的有效性和安全性。2016年1月至2016年10月期间，浙江大学医学院附属儿童医院共有36例患儿接受了nHFOV治疗，其中男24例，女12例，胎龄为（27.5±2.5）周，出生体重为（980±318）g。回顾性收集并分析nHFOV治疗前后的呼吸机设置、副作用及呼吸功能变化数据。采用非参数检验或检验或χ(2)检验。36例患儿中，32例（89%）在使用nHFOV后成功避免了气管插管或再次插管。17例在其他无创通气失败后将nHFOV作为挽救治疗，其余19例在拔管后将nHFOV作为预防再次插管的预防性治疗。作为挽救治疗开始nHFOV 24小时后，呼吸暂停和血氧饱和度降低（SpO(2)<0.85）的发生率、PaCO(2)水平和FiO(2)均显著降低（分别为（1.2±1.1）.（6.3±2.1）次、（1.1±1.2）.（4.3±1.5）次、（43±8）.（56±10）mmHg、0.30±0.07. 0.39±0.11；1 mmHg = 0.133 kPa，分别为7.562、8.913、4.179、3.437，均<0.01）。作为拔管后预防性治疗开始nHFOV 24小时后，FiO(2)和PaCO(2)水平无显著变化（0.42±0.12.0.40±0.10，（49±8）.（48±7）mmHg，分别为0.872和0.501，均>0.05），但平均气道压显著降低（（7.9±2.6）.（9.6±1.6）cmH(2)O，1 cmH(2)0 = 0.098 kPa，= 2.198，= 0.041）。有4例发生鼻中隔损伤，未发现其他与nHFOV相关的并发症。nHFOV可作为其他无创通气失败后的挽救治疗应用于早产儿，或预防性应用于有再次插管高风险的患者。
