| Objective：Neonatal respiratory distress syndrome (NRDS) is a diseasecaused by a deficiency of pulmonary surfactant (PS), which results inend-expiratory alveolar collapse, occurred shortly after birth, and thus thesymptoms of progressive dyspnea, moaning exhale, three depressions sign andrespiratory failure. The lack of PS causes the increase in alveolar surfacetension, the reduction in end-expiratory functional residual capacity, alveolarcollapse, decreased lung compliance, and more work breathing. The surfacetension at alveolus tends to make expansion difficult and eventually leads toCO2retention, seriously affecting the body’s ventilation. Respiratory support isone of the major means to treat NRDS. Mechanical ventilation facilitatesalveolus ventilation increased and discharge of CO2, which provides sufficientO2and reduces the work of breathing. Thus it can rapidly improve oxygenation,and prevent alveolar collapse.Although mechanical ventilation has a significant effect in the treatmentof NRDS, it is likely to cause air leak, pulmonary hemorrhage, ventilatorassociated pneumonia (VAP), bronchopulmonary dysplasia (BPD) and othernegative injuries. Moreover, the medical treatment expense is high. In order toimprove the life quality of infant patients, non-invasive assisted ventilation hasbeen widely applied in the treatment of NRDS recently. In addition，non-invasive assisted ventilation can prevent complications caused by invasiveventilation to some extent while reexpanding collapsed alveoli.Nasal continuous positive airway pressure (NCPAP) is the mainstreamtreatment of non-invasive ventilation. In recent years, there have been manyreports on the application of NCPAP in the treatment of NRDS. Especially, ithas a good effect in reducing acute&chronic lung injuries caused by trachea cannula invasive ventilation, pulmonary or systemic infection. NCPAP hasbeen widely used in clinical treatment of NRDS because it has a significanttreatment effect and can prevent complications caused by invasive ventilation.However, along with the clinical widely application, clinical research hasshown that although some NRDS patients with serious conditions still requirestrachea cannula mechanical ventilation even if they are treated with NCPAPand some problems that cannot be neglected have emerged. They have a higherincidence of nose injury, abdominal distension, air leak, CO2retention, andother complications, which have gained more and more concerns. Humidifiedhigh flow nasal cannula (HHFNC) evolved from nasal catheter oxygen therapyand has become another non-invasive respiratory support mode widely appliedabroad. HHFNC delivers an air-oxygen flow mixture in a closed catheter withthe flow rate of larger than1L/min to produce positive airway pressure andthus improve the ventilation function; the closed catheter can avoid water loss,airway cooling, accumulation of respiratory secretions and irritation to nose.Compared with NCPAP, HHFNC catheter is provided with a connector moreconvenient and easier for operation. Moreover, it does not increase thepossibility of nose injury, abdominal distension and other complications. Somerelated researches have proved HHFNC has not positive or negative effect onthe neonatal respiratory system.In this single center prospective randomized controlled clinical research,the treatment effects of HHFNC and NCPAP in the treatment of NRDS areobserved and compared, and the possibility of reducing the trachea cannulamechanical ventilation application and the incidence of abdominal distension,frequent hemorrhoid, BPD and other complications by the application ofHHFNC is discussed, which provides a new non-invasive ventilation mode forclinicians in the treatment of NRDS.Method:69cases diagnosed with NRDS and admitted in the neonatalintensive care unit of the Hebei Provincial Children Hospital from January toJuly of2012have been selected in this randomized controlled study. They areclassified into two experimental groups:34cases were treated with HHFNC (referred to as the HHFNC group) and35cases were treated with NCPAP(referred to as the NCPAP group). All the selected patients took the bovinepulmonary surfactant replacement therapy and related conventional therapies.NCPAP and HHFNC were applied to different groups respectively. The bloodgas analysis, the clinical symptom improvement, the ventilation time, theoxygen therapy time, length of hospital stay, the mortality rate and theincidence of complications have been observed. The differences in efficacy inthe treatment of NRDS by HHFNC and NCPAP have been observed. Thestatistics software SPSS19.0is used for data processing and the tested data areverified to see whether they are normally distributed. The observation indexesare indicated as x_±s. T-test and χ~2have been adopted.Results:120cases of patients are included in the HHFNC group and21in theNCPAP group. There is no statistical significance in differences in admissiondate, birth weight, gestational age, PS application time after birth, M-F ratio,mode of delivery, twins and Class II&Class III NRDS distribution in the twogroups (P>0.05).2There is no statistical significance in the differences in PaO2and PCO2in the two groups (P>0.05) at the beginning of the treatment (0hour).12h,24hand72h after the treatment, PaO2of the HHFNC group and the NCPAP grouphave been significantly improved. There is statistical significance in thecomparison differences at different time within each group (P<0.05), but nostatistical significance in the differences at different time between the twogroups (P>0.05). The values of P are higher than0.05in the comparison ofPaCO2at different time within a group or between the two groups. There isstatistical significance in the comparison differences (P>0.05).3There is no statistical significance in the comparison difference of P/F,a/APO2and SaO2for the two groups at the beginning of the treatment (0hour)(P>0.05);12h,24h and72h after the treatment, P/F, a/APO2and SaO2for boththe HHFNC group and the NCPAP group have been improved. There isstatistical significance in the comparison differences at different time within each group (P<0.05); SaO2of the HHFNC group has better improvement thanthe NCPAP group, and there is statistical significance in the comparisondifferences (P<0.05); however, there is no statistical significance in thedifferences of P/F and a/APO2between the two groups (P>0.05).4Compared with the NCPAP group, the oxygen therapy time and thebreastfeeding initiation time of the HHFNC group are significantly shortened,and there is statistical significance in the differences (P<0.05); there is nostatistical significance in the comparison differences in ventilator applicationtime, length of hospital stay and total cost of hospitalization (P>0.05).5Compared with the NCPAP group, the incidence of abdominaldistention, nose injury and repositioning of the cannula for the HHFNC groupis lower, and there is statistical significance in the differences (for abdominaldistension, nose injury and repositioning of the cannula, values of P are alllower than0.05); there is no statistical significance in the comparisondifferences in air leak, BPD incidence and mortality rate (P>0.05).Conclusions:1Upon observation after treatment, PaO2, P/F, a/ApO2and SaO2for boththe HHFNC group and the NCPAP group have been significantly improved.Both non-invasive ventilation modes have the good effect in the treatment ofNRDS and can improve the oxygenation and the ventilation obviously.2Compared with NCPAP, by applying HHFNC in the treatment ofNRDS, the breastfeeding initiation time was advanced, and the incidence ofabdominal distension&nose injury were reduced effectively; there is nodifference in the BPD incidence, frequent hemorrhoid incidence and mortalityrate between the two groups.3Compared with NCPAP, HHFNC has shortened the oxygen exposuretime and reduced the probability of repositioning of the cannula. There is nodifference in the ventilator application time, length of hospital stay and totalcost of hospitalization between the two groups.4Compared with NCPAP, HHFNC is characterized by the smallernegative injury and the better tolerance. It promotes the life quality of infant patients and is a preferred non-invasive ventilation mode in the treatment ofNNRDS for clinicians. |
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