Application of noninvasive high frequency oscillation ventilation in initial respiratory support of very low birth weight premature infants with respiratory distress syndrome

doi:10.3877/cma.j.issn.1673-5250.2021.05.014

Objective

To explore the clinical efficacy of transnasal noninvasive high frequency oscillation ventilation (NHFOV) in initial respiratory support of very low birth weight premature infants with respiratory distress syndrome (RDS).

Methods

A total of 92 cases of very low birth weight premature infants with RDS in neonatal intensive care unit(NICU) of Xuzhou Central Hospital from February 2018 to April 2020 were selected as research subjects. Through random number table method, they were divided into NHFOV group (n=48, used NHFOV noninvasive ventilation mode) and nasal continuous positive airway pressure (NCPAP) group (n=44, used NCPAP noninvasive ventilation mode). Their general clinical data, arterial blood gas analysis indicators before and after noninvasive ventilation treatment, therapeutic effect of noninvasive ventilation, incidences of complications related to respiratory support treatment and mortality rate were compared between 2 groups of very low birth weight premature infants with RDS by independent-samples t test, chi-square test and Mann-Whitney U test. This study was approved by the Medical Ethics Committee of Xuzhou Central Hospital (Approval No. XZXY-LJ-20170328-006). And all the children′s guardians signed informed consents of this study.

Results

①Comparison results of general clinical data: there were no significant differences between two groups in terms of gender, gestational age, birth weight, Apgar scores at 1 min and 5 min after birth, age of admission and maternal glucocorticoid use rate 24 h before delivery (P>0.05). ②Inter-group comparison: arterial blood gas analysis indexes of arterial partial pressure of carbon dioxide (PaCO₂) at 1 h and 24 h after noninvasive ventilation treatment in NHFOV group were (45.8±6.5) mmHg (1 mmHg=0.133 kPa) and (40.8±4.7) mmHg, respectively, which were significantly lower than those of (49.3±5.7) mmHg and (44.2±5.2) mmHg in NCPAP group accordingly; and the ratio of arterial oxygen partial pressure (PaO₂) to fraction of inspired oxygen (FiO₂) (P/F) at 1 and 24 h after treatment were (198.8±30.5) mmHg and (215.1±32.1) mmHg in NHFOV group, respectively, which were significantly higher than those of (176.4±28.1) mmHg and (190.0±29.7) mmHg in NCPAP group, and all differences mentioned above were statistically significant (t=2.809, 3.301, 3.663, 3.881; P=0.003, <0.001, <0.001, <0.001). ③Intra-group comparison: arterial blood gas analysis indexes of pH value at 24 h and PaCO₂ levels at 1 and 24 h after noninvasive ventilation were all better improved than those before treatment, and P/F value at 24 h after treatment was higher than that at 1 h after treatment (P<0.05). ④ Comparison results of therapeutic effects of noninvasive ventilation between two groups: treatment rate with pulmonary surfactant (PS) and treatment rate of invasive mechanical ventilation in NHFOV group (22.9% and 6.3%) were significantly lower than those in NCPAP group (45.5% and 20.5%) after noninvasive ventilation treatment, and their differences were statistically significant (χ²=5.219, 4.084; P=0.022, 0.043). There were no significant differences of duration of noninvasive ventilation, treatment rate with caffeine citrate, incidence of frequent apnea and total treatment time of oxygen inhalation between two groups (P>0.05). ⑤ There were no significant differences in incidence of nasal injury, pulmonary air leakage, neonatal necrotic enterocolitis (NEC), grade Ⅲ-Ⅳ intraventricular hemorrhage (IVH), retinopathy of prematurity (ROP) (≥grade Ⅱ), bronchopulmonary dysplasia (BPD), and mortality between two groups (P>0.05).

Conclusions

Compared with NCPAP in initial respiratory support treatment of very low birth weight premature infants with RDS, NHFOV can improve oxygenation, prevent carbon dioxide (CO₂) retention, reduce the use of invasive mechanical ventilation and exogenous PS, and not increase the incidence of several complications related to respiratory support therapy.

Key words: Continuous positive airway pressure, Noninvasive high frequency oscillation ventilation, Respiratory distress syndrome, newborn, Pulmonary surfactant, Blood gas analysis, Infant, very low birth weight, Infant, premature

表1 2组RDS极低出生体重早产儿一般临床资料比较

组别	例数	男性患儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	Apgar评分(分，±s)		入院日龄(h，±s)	分娩前24 h母亲使用糖皮质激素[例数(%)]
组别	例数	男性患儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	生后1 min	生后5 min	入院日龄(h，±s)	分娩前24 h母亲使用糖皮质激素[例数(%)]
NHFOV组	48	25(52.1)	29.5±1.3	1 288±115	5.3±1.7	7.9±2.2	3.3±1.4	22(45.8)
NCPAP组	44	24(54.5)	29.8±1.3	1 296±128	5.8±1.7	7.8±2.1	2.9±1.2	19(43.2)
检验值		χ²＝0.056	t＝1.150	t＝0.312	t＝1.447	t＝0.200	t＝1.401	χ²＝0.065
P值		0.813	0.127	0.378	0.076	0.421	0.082	0.798

表1 2组RDS极低出生体重早产儿一般临床资料比较

组别	例数	男性患儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	Apgar评分(分，±s)		入院日龄(h，±s)	分娩前24 h母亲使用糖皮质激素[例数(%)]
组别	例数	男性患儿[例数(%)]	出生胎龄(周，±s)	出生体重(g，±s)	生后1 min	生后5 min	入院日龄(h，±s)	分娩前24 h母亲使用糖皮质激素[例数(%)]
NHFOV组	48	25(52.1)	29.5±1.3	1 288±115	5.3±1.7	7.9±2.2	3.3±1.4	22(45.8)
NCPAP组	44	24(54.5)	29.8±1.3	1 296±128	5.8±1.7	7.8±2.1	2.9±1.2	19(43.2)
检验值		χ²＝0.056	t＝1.150	t＝0.312	t＝1.447	t＝0.200	t＝1.401	χ²＝0.065
P值		0.813	0.127	0.378	0.076	0.421	0.082	0.798

表2 2组RDS极低出生体重早产儿无创通气治疗前、后动脉血气分析指标比较(±s)

组别	例数	血清pH值			PaCO₂(mmHg)			P/F(mmHg)
组别	例数	治疗前	治疗后1 h	治疗后24 h	治疗前	治疗后1 h	治疗后24 h	治疗后1 h	治疗后24 h
NHFOV组	48	7.26±0.10	7.29±0.08	7.38±0.07	56.3±8.2	45.8±6.5	40.8±4.7	198.8±30.5	215.1±32.1
NCPAP组	44	7.27±0.12	7.30±0.09	7.37±0.06	54.9±7.7	49.3±5.7	44.2±5.2	176.4±28.1	190.0±29.7
t值		0.436	0.564	0.732	0.812	2.809	3.301	3.663	3.881
P值		0.332	0.287	0.233	0.209	0.003	<0.001	<0.001	<0.001

表2 2组RDS极低出生体重早产儿无创通气治疗前、后动脉血气分析指标比较(±s)

组别	例数	血清pH值			PaCO₂(mmHg)			P/F(mmHg)
组别	例数	治疗前	治疗后1 h	治疗后24 h	治疗前	治疗后1 h	治疗后24 h	治疗后1 h	治疗后24 h
NHFOV组	48	7.26±0.10	7.29±0.08	7.38±0.07	56.3±8.2	45.8±6.5	40.8±4.7	198.8±30.5	215.1±32.1
NCPAP组	44	7.27±0.12	7.30±0.09	7.37±0.06	54.9±7.7	49.3±5.7	44.2±5.2	176.4±28.1	190.0±29.7
t值		0.436	0.564	0.732	0.812	2.809	3.301	3.663	3.881
P值		0.332	0.287	0.233	0.209	0.003	<0.001	<0.001	<0.001

表3 2组RDS极低出生体重早产儿无创通气疗效比较

组别	例数	无创通气时间(d，±s)	使用PS[例数(%)]	使用柠檬酸咖啡因[例数(%)]	改为有创机械通气[例数(%)]	频繁呼吸暂停[例数(%)]	总用氧时间[d，M(P₂₅~P₇₅)
NHFOV组	48	4.1±0.7	11(22.9)	45(93.8)	3(6.3)	3(6.3)	11.0(8.8~10.4)
NCPAP组	44	4.3±0.9	20(45.5)	42(95.5)	9(20.5)	6(13.6)	11.3(8.6~9.8)
检验值		t＝1.326	χ²＝5.219	χ²＝0.010	χ²＝4.084	χ²＝0.706	Z＝-0.366
P值		0.094	0.022	0.920	0.043	0.401	0.716

表3 2组RDS极低出生体重早产儿无创通气疗效比较

组别	例数	无创通气时间(d，±s)	使用PS[例数(%)]	使用柠檬酸咖啡因[例数(%)]	改为有创机械通气[例数(%)]	频繁呼吸暂停[例数(%)]	总用氧时间[d，M(P₂₅~P₇₅)
NHFOV组	48	4.1±0.7	11(22.9)	45(93.8)	3(6.3)	3(6.3)	11.0(8.8~10.4)
NCPAP组	44	4.3±0.9	20(45.5)	42(95.5)	9(20.5)	6(13.6)	11.3(8.6~9.8)
检验值		t＝1.326	χ²＝5.219	χ²＝0.010	χ²＝4.084	χ²＝0.706	Z＝-0.366
P值		0.094	0.022	0.920	0.043	0.401	0.716

表4 2组RDS极低出生体重早产儿呼吸支持治疗相关并发症发生率及患儿死亡率比较[例数(%)]

组别	例数	鼻损伤^a	肺气漏^b	NEC	IVH(Ⅲ~Ⅳ级)	ROP(≥Ⅱ期)	BPD	死亡
NHFOV组	48	3(6.3)	2(4.2)	1(2.1)	2(4.2)	1(2.1)	2(4.2)	2(4.2)
NCPAP组	44	4(9.1)	1(2.3)	2(4.5)	1(2.3)	2(4.5)	3(6.8)	1(2.3)
χ²值		0.014	0.006	0.006	0.006	0.006	0.010	0.006
P值		0.905	0.939	0.939	0.939	0.939	0.920	0.939

表4 2组RDS极低出生体重早产儿呼吸支持治疗相关并发症发生率及患儿死亡率比较[例数(%)]

组别	例数	鼻损伤^a	肺气漏^b	NEC	IVH(Ⅲ~Ⅳ级)	ROP(≥Ⅱ期)	BPD	死亡
NHFOV组	48	3(6.3)	2(4.2)	1(2.1)	2(4.2)	1(2.1)	2(4.2)	2(4.2)
NCPAP组	44	4(9.1)	1(2.3)	2(4.5)	1(2.3)	2(4.5)	3(6.8)	1(2.3)
χ²值		0.014	0.006	0.006	0.006	0.006	0.010	0.006
P值		0.905	0.939	0.939	0.939	0.939	0.920	0.939

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