目的 评估高流量鼻导管（HFNC）作为主要呼吸支持治疗的新生儿重症肺炎（NSP）无创通气的效果并探讨其失败的预测因素。方法 本研究回顾性分析了2019年1月—2021年12月我院新生儿重症监护室收治的NSP新生儿85例。所有患儿接受HFNC作为主要支持治疗。HFNC失败定义为需要升级到无创通气或有创机械通气。根据HFNC治疗前以及治疗后30、60、 120、720 min时获得的临床数据,对HFNC成功组（反应者）和HFNC失败组（无反应者）进行了比较。结果 在85名新产儿中,13名患者（15.29%,13/85）出现HFNC失败,72名患者（84.71%,72/85）成功通气。与HFNC失败组相比,HFNC成功组的胎龄、出生体重、HFNC的持续时间明显增加,以及呼吸窘迫评分、住院天数显著降低。基线血气参数比较显示,HFNC成功组呼吸评分（RS）较HFNC失败组显著降低,SpO2/FiO2（S/F）、SpO2、pH显著升高。根据逻辑回归分析,胎龄、呼吸窘迫的严重性、RS和S/F可预测HFNC失败。两组患者在HFNC治疗后RR、HR、RS和FiO2显著降低,SpO2和S/F比增加。与HFNC成功组相比,HFNC失败组在HFNC治疗后RS、FiO2显著降低,SpO2和S/F比增加。与HFNC失败组相比,HFNC成功组30 min和60 min的S/F目标、30 min的RR目标和30 min 的RS目标的实现率更高。在逻辑回归分析中,60 min的S/F目标实现显著预测了HFNC成功治疗（OR=8.035,95%CI：2.980~21.658）。结论 HFNC适用于NSP新生儿的呼吸窘迫/衰竭治疗,并且在HFNC治疗前或治疗60分钟时,S/F比可以用作监测治疗失败的早期预警指标。
Abstract
Objective To investigate the effect and predictors of failure of high-flow nasal cannula (HFNC) as the primary respiratory support therapy for non-invasive ventilation in severe neonatal pneumonia (NSP). Methods This study retrospectively analyzed 85 neonates with NSP admitted to the neonatal intensive care unit of our hospital from January 2019 to December 2021. All patients received HFNC as primary supportive care. HFNC failure was defined as the need for escalation to noninvasive ventilation or invasive mechanical ventilation. Based on clinical data obtained before HFNC treatment and at 30, 60, 120, and 720 min after treatment, HFNC success (responders) and HFNC failure groups (non-responders) were compared. Results Among 85 neonatal infants, 13 patients (15.29%, 13/85) experienced HFNC failure, and 72 patients (84.71%, 72/85) were successfully ventilated. Compared with the failed HFNC group, the gestational age, birth weight, and duration of HFNC in the successful HFNC group were significantly increased, as well as the respiratory distress score and the length of hospital stay were significantly decreased. The comparison of baseline gas and blood parameters showed that the RS of the successful HFNC group was significantly lower than that of the failed HFNC group, and the SpO2/FiO2 (S/F), SpO2 and pH were significantly increased. Gestational age, severity of respiratory distress, RS and S/F predicted HFNC failure according to logistic regression analysis. After HFNC treatment, RR, HR, RS and FiO2 were significantly decreased in both groups, and SpO2 and S/F ratio were increased. Compared with the successful HFNC group, the HFNC failure group had significantly lower RS and FiO2 after HFNC treatment, and increased SpO2 and S/F ratio. The achievement rate of S/F goals at 30 min and 60 minutes, RR goals at 30 minutes, and RS goals at 30 minutes was higher in the HFNC success group compared with the HFNC failure group. In logistic regression analysis, the 60-min S/F target significantly predicted successful HFNC treatment (OR=8.035, 95%CI 2.980-21.658). Conclusions HFNC is suitable for the treatment of respiratory distress/failure of NSP newborns, and S/F ratio can be used as an early warning index to monitor the failure of treatment before or 60 minutes after HFNC treatment.
关键词
高流量鼻导管 /
新生儿肺炎 /
治疗效果 /
无创通气
Key words
high-flow nasal cannula /
neonatal pneumonia /
treatment effect /
noninvasive ventilation
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参考文献
[1] 单丽琴, 周庆女, 黄华飞. 有创-无创序贯机械通气治疗新生儿重症肺炎伴呼吸衰竭的疗效观察[J]. 浙江医学, 2020, 42(2): 181-183.
[2] 邓云森, 李盛强, 林丽妮, 等. 血清25- (OH) D, hs-CRP, PCT与新生儿重症肺炎的关系研究[J]. 中国急救复苏与灾害医学杂志, 2020, 15(1): 75-77.
[3] 谢朝云, 蒙桂鸾, 熊芸, 等. 新生儿重症监护病房中重症肺炎多种菌感染相关因素分析[J]. 临床儿科杂志, 2020, 38(4): 260-263.
[4] 陈倩倩, 徐秀小, 李跃. 精细化护理在新生儿重症肺炎合并呼吸衰竭护理中的应用观察[J]. 重庆医学, 2020, 49(S01): 408-410.
[5] 杨文娜, 张琳. 保守氧疗法在重症肺炎机械通气患者中的应用效果观察[J]. 中华危重病急救医学, 2021, 33(9): 1069-1073.
[6] FAINARDI V, ABELLI L, MUSCARÀ M, et al.Update on the role of high-flow nasal cannula in infants with bronchiolitis[J]. Children, 2021, 8(2): 66.
[7] CONTE F, ORFEO L, GIZZI C, et al.Rapid systematic review shows that using a high-flow nasal cannula is inferior to nasal continuous positive airway pressure as first-line support in preterm neonates[J]. Acta Paediatr, 2018, 107(10): 1684-1696.
[8] CANNING A, FAIRHURST R, CHAUHAN M, et al.Oral feeding for infants and children receiving nasal continuous positive airway pressure and high-flow nasal cannula respiratory supports: a survey of practice[J]. BMC Pediatr, 2021, 21: 83.
[9] OKTEM A, YIGIT S, OĞUZ B, et al. Accuracy of lung ultrasonography in the diagnosis of respiratory distress syndrome in newborns[J]. J Matern Fetal Neonatal Med, 2021, 34(2): 281-286.
[10] ŞIK N, ŞENOL H B, ÇAĞLAR A, et al. Early application of non-invasive ventilation for children with pulmonary edema after drowning[J]. Pediatr Int, 2022, 64(1): e14858.
[11] LUO J, DUKE T, CHISTI M J, et al. Efficacy of high-flow nasal cannula vs standard oxygen therapy or nasal continuous positive airway pressure in children with respiratory distress: a meta-analysis[J]. J Pediatr, 2019, 215: 199-208. e8.
[12] PAPOFF P, CARESTA E, LUCIANI S, et al.The starting rate for high-flow nasal cannula oxygen therapy in infants with bronchiolitis: Is clinical judgment enough?[J]. Pediatr Pulmonol, 2021, 56(8): 2611-2620.
[13] YILDIZDAS D, YONTEM A, IPLIK G, et al.Predicting nasal high-flow therapy failure by pediatric respiratory rate-oxygenation index and pediatric respiratory rate-oxygenation index variation in children[J]. Eur J Pediatr, 2021, 180(4): 1099-1106.
[14] ROCA O, CARALT B, MESSIKA J, et al.An index combining respiratory rate and oxygenation to predict outcome of nasal high-flow therapy[J]. Am J Respir Crit Care Med, 2019, 199(11): 1368-1376.
[15] KIM G E, CHOI S H, PARK M, et al.SpO2/FiO2 as a predictor of high flow nasal cannula outcomes in children with acute hypoxemic respiratory failure[J]. Sci Rep, 2021, 11(1): 13439.
[16] SLATER A, STRANEY L, ALEXANDER J, et al.The effect of imputation of PaO2/FiO2 from SpO2/FiO2 on the performance of the pediatric index of mortality 3[J]. Pediatr Crit Care Med, 2020, 21(6): 520-525.
[17] RAY S, ROGERS L, PAGEL C, et al.PaO2/FiO2 ratio derived from the SpO2/FiO2 ratio to improve mortality prediction using the pediatric index of mortality-3 score in transported intensive care admissions[J]. Pediatr Crit Care Med, 2017, 18(3): e131-e136.
[18] Pediatric Acute Lung Injury Consensus Conference Group. Pediatric acute respiratory distress syndrome: consensus recommendations from the Pediatric Acute Lung Injury Consensus Conference[J]. Pediatr Crit Care Med, 2015, 16(5): 428-439.
[19] EMERIAUD G, NAPOLITANO N, POLIKOFF L, et al.Impact of failure of noninvasive ventilation on the safety of pediatric tracheal intubation[J]. Crit Care Med, 2020, 48(10): 1503-1512.
基金
四川省卫生健康科研基金项目“血常规生物指标对新生儿肺炎无创呼吸治疗效果及预后的预测价值”（20210826）
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