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目的:观察加热湿化高流量鼻导管辅助通气(HHHFNC)、鼻塞持续正压通气(nCPAP)、呼吸机机械通气(VMV)分别联合肺表面活性物质(PS)治疗早产低出生体质量儿呼吸窘迫综合征(RDS)的临床效果,优选辅助通气方案。方法:将60例RDS早产低出生体质量儿随机分为HHHFNC组21例、nCPAP组20例、VMV组19例,均接受PS替代治疗及其他常规综合治疗,同时分别应用HHHFNC、nCPAP、VMV,比较三组患儿辅助通气时间、开奶时间和相关性损伤及并发症发生情况。结果:HHHFNC组开奶时间为(37.67±16.01)h,早于nCPAP组的(46.85±19.91)h和VMV组的(56.84±27.63)h;HHHFNC组辅助通气时间为(67.05±34.76)h,少于nCPAP组的(79.80±40.44)h;HHHFNC组肺出血、呼吸暂停、二氧化碳潴留和鼻腔颜面损伤发生率均低于nCPAP组和VMV组;HHHFNC组重新插管率为9.52%,低于nCPAP组的30.00%和VMV组的42.11%(P均<0.05)。结论:HHHFNC是一种有效无创的呼吸支持模式,应用于早产低出生体质量儿,耐受性好,相关性损伤及并发症少,在HHHFNC、nCPAP、VMV三种辅助通气方案中最具优势。
Objective: To observe the effects of heating and humidifying high flow nasal catheter assisted ventilation (HHHFNC), nasal continuous positive airway pressure (nCPAP) and ventilator mechanical ventilation (VMV) and pulmonary surfactant (PS) on the treatment of preterm low birth weight infants with respiratory distress Syndrome (RDS) of the clinical effect, preferably assisted ventilation program. Methods: Sixty children with preterm birth and low birth weight were randomly divided into HHHFNC group (21 cases), nCPAP group (20 cases) and VMV group (19 cases). All of them were treated with PS replacement therapy and other conventional combined therapy. HHHFNC, nCPAP, The three groups of children assisted ventilation time, opening milk time and related injuries and complications occurred. Results: The opening time of the HHHFNC group was (37.67 ± 16.01) h, earlier than that of the nCPAP group (46.85 ± 19.91) h and (56.84 ± 27.63) h in the VMV group, and was 67.05 ± 34.76 h in the HHHFNC group, Less than nCPAP group (79.80 ± 40.44) h. The incidences of pulmonary hemorrhage, apnea, carbon dioxide retention and nasal facial injury in HHHFNC group were lower than those in nCPAP group and VMV group. The reperfusion rate in HHHFNC group was 9.52% 30.00% of the group and 42.11% of the VMV group (all P <0.05). Conclusion: HHHFNC is an effective and noninvasive respiratory support model, which is suitable for preterm low birth weight children. It is well tolerated and has fewer related injuries and complications. HHHFNC has the most advantages in three types of assisted ventilation programs: HHHFNC, nCPAP and VMV .