无创高频振荡通气在早产儿有创机械通气撤机后呼吸支持效果的随机对照研究

李欢欢; 朱兴旺; 汪万军

doi:10.16016/j.1000-5404.201903161

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无创高频振荡通气在早产儿有创机械通气撤机后呼吸支持效果的随机对照研究

临床医学 | 更新时间：2026-01-09

- 无创高频振荡通气在早产儿有创机械通气撤机后呼吸支持效果的随机对照研究
- Efficacy of non-invasive high frequency oscillatory ventilation as post-extubation respiratory support in preterm neonates: a randomized controlled trial
- 第三军医大学学报 2019年41卷第17期页码：1688-1692
- 作者机构：
  
  1.400000 重庆，九龙坡区人民医院新生儿科
  2.400014 重庆，重庆医科大学附属儿童医院新生儿诊疗中心
- 作者简介：
  
  [ 汪万军，E-mail:119554998@qq.com WANG Wanjun, E-mail:119554998@qq.com
- 基金信息：
- DOI：10.16016/j.1000-5404.201903161
  中图分类号： R181.32;R454.4;R722.6
- 收稿：2019-03-20，
  
  修回：2019-06-13，
  
  纸质出版：2019-09-15
- 稿件说明：
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李欢欢, 朱兴旺, 汪万军. 无创高频振荡通气在早产儿有创机械通气撤机后呼吸支持效果的随机对照研究[J]. 第三军医大学学报, 2019,41(17):1688-1692.

Huanhuan LI, Xingwang ZHU, Wanjun WANG. Efficacy of non-invasive high frequency oscillatory ventilation as post-extubation respiratory support in preterm neonates: a randomized controlled trial[J]. Journal of Third Military Medical University, 2019, 41(17): 1688-1692.
李欢欢, 朱兴旺, 汪万军. 无创高频振荡通气在早产儿有创机械通气撤机后呼吸支持效果的随机对照研究[J]. 第三军医大学学报, 2019,41(17):1688-1692. DOI： 10.16016/j.1000-5404.201903161.

Huanhuan LI, Xingwang ZHU, Wanjun WANG. Efficacy of non-invasive high frequency oscillatory ventilation as post-extubation respiratory support in preterm neonates: a randomized controlled trial[J]. Journal of Third Military Medical University, 2019, 41(17): 1688-1692. DOI： 10.16016/j.1000-5404.201903161.

摘要

目的

比较无创高频振荡通气(noninvasive high-frequency oscillatory ventilation，NHFOV)和经鼻持续气道正压通气(nasal continuous positive airway pressure

NCPAP)作为胎龄26

周~31

周早产儿有创机械通气拔管后无创呼吸支持的疗效。

方法

收集2017年1月至2019年1月九龙坡区人民医院新生儿科和重庆医科大学附属儿童医院新生儿诊疗中心收治的早产儿114例，通过抽取信封法随机分成两组:治疗组接受NHFOV治疗(

=56)；对照组接受NCPAP治疗(

=58例)。主要评价指标是两组早产儿在撤离有创机械通气后7 d内无创通气失败需要再次气管插管的比例，次要评价指标包括无创通气支持时间、住院天数和住院死亡、气胸、校正胎龄36周或离院时支气管肺发育不良(bronchopulmonary dysplasia，BPD)、坏死性小肠结肠炎(necrotizing enterocolitis，NEC)、颅内出血(intracranial hemorrhage，IVH)发生情况。

结果

在撤离有创机械通气后7 d内无创通气失败需要再次气管插管的比例方面，NHFOV组明显低于NCPAP组(14.2%

31.0%，

=0.033)；两组次要评价指标比较差异均无统计学意义。

结论

与NCPAP比较，NHFOV作为早产儿有创机械通气拔管后无创呼吸支持可以提高撤机成功率，减少再次气管插管。

Abstract

Objective

To compare the efficacy of non-invasive high-frequency oscillatory ventilation (NHFOV) with nasal continuous positive airway pressure (NCPAP) in preterm infants aged 26

~31

weeks as post-extubation respiratory support.

Methods

A total of 114 infants admitted to Department of Neonatology

Jiulongpo District People's Hospital and Diagnosis and Treatment Center for Neonates of Children's Hospital of Chongqing Medical University during January 2017 to January 2019 were recruited

and randomized to NCPAP gr

oup (

=58

control) and NHFOV group (

=56) by envelope extraction. The primary outcomes were treatment failure and need for re-intubation within 7 d after extubation. Secondary outcomes included duration of noninvasive ventilation

length of hospitalization

mortality

and incidences of pneumothorax

bronchopulmonary dysplasia (BPD) at 36 weeks of postmenstrual age or discharge

intracranial hemorrhage (IVH) and necrotizing enterocolitis (NEC).

Results

The rate of treatment failure and need for re-intubation within 7 d after extubation was significantly lower in the NHFOV group than the NCPAP group (14.2%

31.0%

=0.033). There were no statistically differences in all other secondary outcomes between the 2 groups.

Conclusion

NHFOV can improve the success rate of weaning and reduce the need for re-intubation as compared with NCPAP in preterm infants after extubation.

关键词

Keywords

references

FISCHER H S, SCHMÖLZER G M, CHEUNG P Y, et al . Sustained inflations and avoiding mechanical ventilation to prevent death or bronchopulmonary dysplasia: a meta-analysis[J ] . Eur Respir Rev, 2018, 27(150): 180083. DOI:10.1183/16000617.0083-2018.

JENSEN E A, SCHMIDT B. Epidemiology of bronchopulmonary dysplasia[J]. Birth Defects Res A, 2014, 100(3): 145-157. DOI:10.1002/bdra.23235.

STEFANESCU B M, MURPHY W P, HANSELL B J, et al . A randomized, controlled trial comparing two different continuous positive airway pressure systems for the successful extubation of extremely low birth weight infants[J ] . Pediatrics, 2003, 112(5): 10 31-1038. DOI:10.1542/peds.112.5.1031.

BARRINGTON K J, BULL D, FINER N N. Randomized trial of nasal synchronized intermittent mandatory ventilation compared with continuous positive airway pressure after extubation of very low birth weight infants[J]. Pediatrics, 2001, 107(4): 638-641. DOI:10.1542/peds.107.4.638.

DE LUCA D, DELL'ORTO V. Non-invasive high-frequency oscillatory ventilation in neonates: review of physiology, biology and clinical data[J]. Arch Dis Child Fetal Neonatal Ed, 2016, 101(6): F565-F570. DOI:10.1136/archdischild-2016-310664.

COLAIZY T T, YOUNIS U M, BELL E F, et al . Nasal high- frequency ventilation for premature infants[J ] . Acta Paediatr, 2008, 97(11): 1518-1522. DOI:10.1111/j.1651-2227.2008.00900.x.

CZERNIK C, SCHMALISCH G, BVHRER C, et al . Weaning of neonates from mechanical ventilation by use of nasopharyngeal high-frequency oscillatory ventilation: A preliminary study[J ] . J Matern Fetal Neonatal Med, 2012, 25(4): 374-378. DOI:10.3109/14767058.2011.580401.

MUKERJI A, SINGH B, HELOU S E, et al . Use of noninvasive high-frequency ventilation in the neo natal intensive care unit: A retrospective review[J ] . Am J Perinatol, 2015, 30(2): 171-176. DOI:10.1055/s-0034-1381317.

王陈红, 施丽萍, 马晓路, 等.无创高频振荡通气模式在极低出生体重儿呼吸支持中的应用[J].中华儿科杂志, 2017, 55(3): 177-181. DOI:10.3760/cma.j.issn.0578-1310.2017.03.003.

WANG C H, SHI L P, MA X L, et al . Use of noninvasive high-frequency oscillatory ventilation in very low birth weight infants[J ] . Chin J Pediatr, 2017, 55(3):177-181. DOI:10.3760/cma.j.issn.0578-1310.2017.03.003.

ROBERTS C T, OWEN L S, MANLEY B J, et al . Nasal high-flow therapy for primary respiratory support in preterm infants[J ] . N Engl J Med, 2016, 375(12): 1142-1151. DOI:10.1056/NEJMoa1603694.

O'BRIEN K, CAMPBELL C, BROWN L, et al . Infant flow biphasic nasal continuous positive airway pressure (BP-NCPAP) vs . infant flow NCPAP for the facilitation of extubation in infants' ≤ 1, 250 grams: A randomized controlled trial[J ] . BMC Pediatr, 2012, 12: 43. DOI:10.1186/1471-2431-12-43..

BELL M J, TERNBERG J L, FEIGIN R D, et al . Neonatal necrotizing enterocolitis. Therapeutic decisions based upon clinical staging[J ] . Ann Surg, 1978, 187(1): 1-7. DOI:10.1097/00000658-197801000-00001.

PAPILE L A, BURSTEIN J, BURSTEIN R, et al . Incidence and evolution of subependymal and intraventricular hemorrhage: A study of infants with birth weights less than 1 500 gm[J ] . J Pediatr, 1978, 92(4): 529-534.

VAN DER HOEVEN M, BROUWER E, BLANCO C E. Nasal high frequency ventilation in neonates with moderate respiratory insufficiency[J]. Arch Dis Child Fetal Neonatal Ed, 1998, 79(1): F61-F63. DOI:10.1136/fn.79.1.f61.

MUKERJI A, FINELLI M, BELIK J. Nasal high-frequency oscillations for lung carbon dioxide clearance in the newborn[J]. Neonatology, 2013, 103(3):161-165. DOI:10.1159/000345613.

HADJ-AHMED M A, SAMSON N, NADEAU C, et al . Laryngeal muscle activity during nasal high-frequency oscillatory ventilation in nonsedated newborn lambs[J ] . Neonatology, 2015, 107(3): 199-205. DOI:10.1159/000369120.

娄五斌, 张卫星.经鼻无创高频振荡通气和持续气道正压通气在早产儿呼吸窘迫综合征撤机后的应用比较[J].广东医学, 2017, 38(13): 2037-2040. DOI:10.3969/j.issn.1001-9448.2017.13.027.

LOU W B, ZHANG W X. Comparison of noninvasive high frequency oscillatory ventilation and continuous positive airway pressure ventilation in premature infants with respiratory distress syndrome after weaning[J]. Guangdong Med J, 2017, 38(13): 2037-2040. DOI:10.3969/j.issn.1001-9448.2017.13.027.

张涛, 高薇薇, 陈佳, 等.无创高频通气在新生儿呼吸窘迫综合征撤机后的应用[J].中华新生儿科杂志(中英文), 2017, 32(2): 96-99. DOI:10.3760/cma.j.issn.2096-2932.2017.02.005.

ZHANG T, GAO W W, CHEN J, et al . Non-invasive high frequency ventilation support in the treatment of neonatal respiratory distress syndrome after extubation[J ] . Chin J Neonatol, 2017, 32(2): 96-99. DOI:10.3760/cma.j.issn.2096-2932.2017.02.005.

FISCHER H S, BOHLIN K, BVHRER C, et al . Nasal high-frequency oscillation ventilation in neonates: A survey in five European countries[J ] . Eur J Pediatr, 2015, 174(4): 465-471. DOI:10.1007/s00431-014-2419-y.

ULLRICH T L, CZERNIK C, BVHRER C, et al . Nasal high-frequency oscillatory ventilation impairs heated humidification: A neonatal bench study[J ] . Pediatr Pulmonol, 2017, 52(11): 1455-1460. DOI:10.1002/ppul.23824.

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