探讨加温湿化高流量鼻导管通气(HHHFNC)与经鼻持续气道正压通气(NCPAP) 2种无创通气呼吸支持治疗，对轻度新生儿呼吸窘迫综合征(NRDS)患儿初始治疗的临床效果。

选择2017年6月至2018年11月，徐州市中心医院新生儿重症监护病房(NICU)收治的73例轻度NRDS患儿为研究对象。采用随机数字表法，将其随机分为HHHFNC组(n＝38)与NCPAP组(n＝35)，对其分别采取HHHFNC与NCPAP模式治疗。观察2组患儿初始呼吸支持治疗前及治疗后，动脉血气分析指标，如pH值、动脉血二氧化碳分压(PaCO₂ )及动脉血氧分压(PaO₂)，组间比较采用成组t检验，组内比较，则采用配对t检验。2组无创通气时间及中转机械通气治疗率、无创通气相关并发症发生率比较，分别采用成组t检验或χ²检验。本研究经过徐州市中心医院医学伦理委员会审核、批准(审批文号：XZXY-LJ-20161122-010)，患儿家长均签署临床研究知情同意书。2组患儿性别构成比、出生胎龄、出生体重、入组时日龄、母亲产前24 h至7 d糖皮质激素使用率、HHHFNC或NCPAP治疗中肺表面活性物质(PS)使用率等一般临床资料比较，差异均无统计学意义(P>0.05)。

①HHHFNC组患儿初始呼吸支持治疗后1 h、24 h动脉血气分析指标，如pH值、PaO₂，均较治疗前显著增高，初始呼吸支持治疗后24 h PaCO₂，较治疗前显著降低，并且差异均有统计学意义(pH值比较：t＝2.090、2.945，P＝0.040、0.004; PaO₂比较：t＝8.250、7.730，P均<0.001；PaCO₂比较：t＝9.677、P<0.001)。NCPAP组患儿初始呼吸支持治疗后1 h、24 h动脉血气分析指标，如pH值、PaO₂均较治疗前显著增高，PaCO₂均较治疗前显著降低，并且差异均有统计学意义(pH值比较：t＝2.020、3.632，P＝0.047、0.001；PaO₂比较：t＝10.380、10.797，P均<0.001；PaCO₂比较：t＝2.666、10.627，P＝0.010、<0.001)。2组患儿初始呼吸支持治疗后1 h、24 h的pH值、PaCO₂、PaO₂组间比较，差异均无统计学意义(P>0.05)。②2组患儿无创通气时间、中转机械通气治疗率分别比较，差异均无统计学意义(P>0.05)。HHHFNC组患儿鼻损伤发生率为0，显著低于NCPAP组的17.1%(6/35)，2组比较，差异有统计学意义(χ²＝5.007，P＝0.025)。

HHHFNC与NCPAP对轻度NRDS患儿初始呼吸支持治疗疗效相当，HHHFNC导致的鼻损伤发生率显著低于NCPAP。由于本研究纳入样本量较小，并且未根据轻度NRDS患儿出生胎龄及出生体重进一步分层分析，HHHFNC与NCPAP对轻度NRDS患儿的初始呼吸支持治疗疗效，尚需要多中心、大样本、随机对照试验进一步研究、证实。

To explore clinical effects of heated humidified high flow nasal cannula (HHHFNC) and nasal continuous positive airway pressure (NCPAP) in initial respiratory support to neonates with mild neonatal respiratory distress syndrome (NRDS).

A total of 73 cases of neonates with mild NRDS in neonatal intensive care unit (NICU) of Xuzhou Central Hospital from June 2017 to November 2018 were selected as research subjects. According to random digits table method, they were divided into HHHFNC group (n=38) and NCPAP group (n=35), and they received HHHFNC and NCPAP non-invasive ventilation mode, respectively. The arterial blood gas analysis indexes, such as pH value, arterial partial pressure of carbon dioxide (PaCO₂) and arterial partial pressure of oxygen (PaO₂) before and after initial respiratory support were observed and compared by independent-samples t test between two groups or by pairwise t test within each group. Duration of non-invasive mechanical ventilation, rates of invasive mechanical ventilation treatment and non-invasive mechanical ventilation-related complications of two groups were compared by independent-samples t test or chi-square test. The study was approved by the Medical Ethics Committee of Xuzhou Central Hospital (Approval No. XZXY-LJ-20161122-010) and the informed clinical research consents were signed by the parents of NRDS children. There were no significant differences in the general clinical data between two groups, such as gender composition ratio, gestational age at birth, birth weight, age at enrollment, glucocorticoid utilization rate from 24 h before birth to 7 d after childbirth of pregnant mother, and treatment rate of pulmonary surfactant (PS) during HHHFNC or NCPAP treatment (P>0.05).

①The arterial blood gas analysis indexes pH value and PaO₂ at 1 h and 24 h after initial respiratory support in HHHFNC group were obviously higher than those before treatment, while PaCO₂ at 24 h after initial respiratory support was obviously lower than that before treatment, and all the differences were statistically significant (pH value comparison: t=2.090, 2.945, P=0.040, 0.004; PaO₂ comparison: t=8.250, 7.730, both P<0.001; PaCO₂ comparison: t=9.677, P<0.001). The pH value and PaO₂ at 1 h and 24 h after initial respiratory support in NCPAP group were obviously higher than those before treatment, while PaCO₂ at 1 h and 24 h after initial respiratory support were obviously lower than that before treatment, and all the differences were statistically significant (pH value comparison: t=2.020, 3.632, P=0.047, 0.001; PaO₂ comparison: t=10.380, 10.797, both P<0.001; PaCO₂ comparison: t=2.666, 10.627, P=0.010, <0.001). There were no statistical differences in pH value, PaCO₂ and PaO₂ at 1 h and 24 h after initial respiratory support between two groups (P>0.05). ②There were no statistically significant differences between two groups in duration of non-invasive ventilation and rate of transferring to invasive mechanical ventilation treatment (P>0.05). The incidence of nasal injury in HHHFNC group was 0, which was significantly lower than that 17.1% (6/35) of NCPAP group, and the difference was statistically different (χ²=5.007, P=0.025).

HHHFNC is equally effective compared with NCPAP in initial respiratory support for mild NRDS and the incidence of nasal injury is significantly lower than that of NCPAP. Because the sample size in this study is relatively small, and stratified analysis based on the gestational age and birth weight of NRDS children has not been conducted, the clinical effect of HHHFNC and NCPAP in initial respiratory support for NRDS still needs multi-center, large-sample, randomized controlled trials for further research and confirmation.