探讨经鼻高流量氧疗(HFNC)治疗重症肺炎患儿的疗效。

选取2019年3月至2022年3月在乐山市人民医院儿童重症监护病房(PICU)治疗的未达到有创机械通气标准的67例重症肺炎患儿(平均年龄为11个月)为研究对象。采用随机数字表法，将其随机分为HFNC组(n＝34，采取HFNC治疗者)和对照组(n＝33，采取面罩吸氧治疗者)。对2组患儿均采取抗感染、对症支持等常规肺炎治疗措施。对2组患儿的总住院时间、PICU住院时间、氧疗相关并发症发生率，采用成组t检验、χ²检验或连续性校正χ²检验进行统计学分析。2组患儿不同时间点动脉血氧分压(PaO₂)、动脉血二氧化碳分压(PaCO₂)比较，采用重复测量资料的方差分析方法。本研究遵循的程序符合乐山市人民医院伦理委员会规定，并通过该伦理委员会审查及批准(审批文号：乐市医院伦委〔2019〕23号)。2组患儿性别构成比、重症肺炎病程、月龄等一般临床资料比较，差异均无统计学意义(P>0.05)。

①HFNC组患儿的总住院时间、PICU住院时间分别为(11.7±2.9) d、(7.9±1.8) d，均显著短于对照组的(15.7±3.0) d与(9.9±1.9) d，并且差异均有统计学意义(t＝5.62、4.36，P<0.001)。②2组患儿治疗前与治疗12、24 h时，PaO₂、PaCO₂的治疗措施与时间因素交互效应比较，差异均有统计学意义(F_{治疗×时间}＝6.25、3.74，P_{治疗×时间}＝0.003、0.029)。对2组患儿不同治疗措施的单独效应分析结果显示，治疗12、24 h时，HFNC组患儿的PaO₂均显著高于对照组，而PaCO₂则均显著低于对照组，并且差均有统计学意义(P<0.05)。对2组患儿时间因素的单独效应分析结果显示，治疗前及治疗12、24 h时，2组患儿PaO₂、PaCO₂的组内比较，差异均有统计学意义(P<0.05)。对组内进一步两两比较结果显示，治疗24 h时2组患儿的PaO₂均较组内治疗前增高，治疗24 h时的PaCO₂均较组内治疗前、治疗12 h时降低，治疗12 h时，对照组患儿PaO₂较组内治疗前增高，并且差异均有统计学意义(P<0.05)。③对2组患儿分别采取HFNC与面罩吸氧治疗的相关并发症发生率比较，差异无统计学意义(χ²＝0.71，P＝0.401)。④HFNC组患儿有创机械通气中转治疗率为5.9%(2/34)，显著低于对照组的27.3%(9/33)，并且差异有统计学意义(χ²＝5.58，P＝0.018)。

HFNC较面罩吸氧可更有效改善重症肺炎患儿的缺氧与CO₂潴留，降低有创机械通气中转治疗率，缩短该病患儿的PICU住院时间和总住院时间。由于本研究纳入样本量相对较小，HFNC在重症肺炎患儿中的疗效，仍有待进一步研究、证实。

To explore the effect of high-flow nasal cannula oxygen therapy (HFNC) to children with severe pneumonia.

From March 2019 to March 2022, 67 children (average age of 11 months) with severe pneumonia who were treated in pediatric intensive care unit (PICU) and did not meet the criteria for invasive mechanical ventilation were enrolled in this study. They were randomly divided into HFNC group (n=34, children received HFNC treatment) and control group (n=33, children received mask oxygen inhalation) according to random number table method. Children in two groups were treated with conventional comprehensive treatment for pneumonia, including anti-infection, and symptomatic support therapy. The total length of hospital stay, length of stay in PICU and incidence of complications associated with oxygen therapy of two groups were compared by independent-samples t test, chi-square test or continuity correction chi-square test. The arterial partial pressure of oxygen (PaO₂) and arterial partial pressure of carbon dioxide (PaCO₂) of two groups at different time points were compared by variance of repeated measurement data method. The procedures followed in this study were in accordance with the regulations of the Ethics Committee of Leshan People′s Hospital, and was reviewed and approved by the Ethics Committee (Approval No. [2019]23). There were no statistically significant differences between two groups in general clinical data, such as gender constituent ratio, course of severe pneumonia, age, etc. (P>0.05).

①The total length of hospital stay and length of stay in PICU of children in HFNC group were (11.7±2.9) d and (7.9±1.8) d respectively, which were significantly shorter than those in control group (15.7±3.0) d and (9.9±1.9) d, and both the differences were statistically significant (t=5.62, 4.36; P<0.001). ②There were statistical difference in interactive effects between different treatment measures and time factors of PaO₂ and PaCO₂ in two groups before treatment, at 12 h and 24 h of treatment (F_{treatment×time}=6.25, 3.74; P_{treatment×time}=0.003, 0.029). Further analysis of individual effects of different treatment measures of two groups showed that PaO₂ at 12 h and 24 h of treatment in HFNC group both were higher than those in control group, while PaCO₂ at 12 h and 24 h of treatment in HFNC group both were lower than those in control group, and all differences were statistically significant (P<0.05). Further analysis of individual effects of time factors in two groups showed that there were statistical differences in PaO₂ and PaCO₂ before treatment and at 12 h and 24 h of treatment both in HFNC group and control group (P<0.05). Further pairwise comparison within HFNC group and control group showed that PaO₂ at 24 h of treatment of two groups were statistically higher than those before treatment within group, while PaCO₂ at 24 h of treatment of two groups were statistically lower than those before treatment and at 12 h of treatment within group, PaO₂ at 12 h of treatment of control group was statistically higher than that before treatment within group, and all the differences were statistically significant (P<0.05). ③There was no significant difference in the incidence of complications related to HFNC and mask oxygen inhalation between two groups (χ²=0.71, P=0.401). ④The rate of conversion to invasive mechanical ventilation of children in HFNC group was 5.9% (2/34), which was significantly lower than 27.3% (9/33) in control group, and the difference was statistically significant (χ²=5.58, P=0.018).

Compared with mask oxygen inhalation, HFNC can effectively improve the hypoxia and CO₂ retention of children with severe pneumonia, reduce the rate of conversion to invasive mechanical ventilation, and shorten the length stay in PICU and total length of hospital stay. Because the sample size of this study is relatively small, the efficacy of HFNC in children with severe pneumonia still needs further study to confirm.