Zhang Xian, Wang Gaoxiang, Liu Binbin, Chen Bo, Yang Hong
Department of Ophthalmology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Transl Vis Sci Technol. 2019 Apr 25;8(2):20. doi: 10.1167/tvst.8.2.20. eCollection 2019 Mar.
We evaluated the effect of heated and humidified high flow nasal cannula (HFNC) oxygen supplementation to promote regression of high-risk prethreshold retinopathy of prematurity (Hrp-ROP) in premature infants.
A prospective study was designed for Hrp-ROP premature infants undergoing HFNC oxygen supplementation to evaluate its capacity for promoting ROP regression. Statistical analysis with independent samples -tests and Fisher's exact tests was performed, and forest plots were created to illuminate the odds ratio of factors associated with ROP regression as well as HFNC complication.
With HFNC, 16 of 20 infants with Hrp-ROP experienced regression, which is higher than the natural regression rate, comparing to the data in other clinical trials (52% in the STOP-ROP study). Among four progressed ROP infants, three were treated with laser photocoagulation and one received anti-vascular endothelial growth factor (VEGF) therapy. The anti-VEGF treated patient encountered ROP recurrence one month after injection and was treated successfully by additional HFNC. No significant differences between regression and progression cases were found for gestational age, birth weight, plus disease, age for HFNC, and SO2 level. The blood saturation of oxygen was significantly increased after HFNC (92 ± 1.3% vs. 96.6 ± 0.8%, < 0.001), while the heartbeat rate (HR) and respiratory rate (RR) had no significant differences (139.4 ± 5.4 vs. 140.6 ± 4.5, = 0.409; 37.7 ± 2.3 vs. 37 ± 1.9, = 0.330, respectively). The main complication of HNFC was nasal erosion associated with airflow and HFNC duration (RR = 1.8, = 0.026; RR = 1.8, = 0.026, respectively).
The progression of Hrp-ROP was significantly decreased after HFNC oxygen supplementation with slightly tolerable complication.
Our study suggests that HNFC can be an alternative treatment for Hrp-ROP, potentially avoiding the problems caused by other invasive treatment.
我们评估了加热湿化高流量鼻导管（HFNC）吸氧对促进早产儿高危阈值前视网膜病变（Hrp-ROP）消退的效果。
设计一项前瞻性研究，针对接受HFNC吸氧的Hrp-ROP早产儿，评估其促进ROP消退的能力。采用独立样本t检验和Fisher精确检验进行统计分析，并绘制森林图以阐明与ROP消退及HFNC并发症相关因素的比值比。
使用HFNC时，20例Hrp-ROP婴儿中有16例病情消退，这高于自然消退率，与其他临床试验数据（STOP-ROP研究中的52%）相比。在4例ROP进展的婴儿中，3例接受了激光光凝治疗，1例接受了抗血管内皮生长因子（VEGF）治疗。接受抗VEGF治疗的患者在注射后1个月出现ROP复发，并通过额外的HFNC成功治疗。在胎龄、出生体重、加病、开始使用HFNC的年龄和SO2水平方面，消退和进展病例之间未发现显著差异。使用HFNC后血氧饱和度显著升高（92±1.3%对96.6±0.8%，P<0.001），而心率（HR）和呼吸频率（RR）无显著差异（分别为139.4±5.4对140.6±4.5，P = 0.409；37.7±2.3对37±1.9，P = 0.330）。HFNC的主要并发症是与气流和HFNC使用持续时间相关的鼻黏膜糜烂（RR = 1.8，P = 0.026；RR = 1.8，P = 0.026）。
HFNC吸氧后Hrp-ROP的进展显著降低，且并发症轻微可耐受。
我们的研究表明，HFNC可作为Hrp-ROP的替代治疗方法，可能避免其他侵入性治疗引起的问题。
