摘要
目的探讨经鼻导管高流量氧疗(HFNC)在儿童呼吸衰竭中的应用效果。方法前瞻性研究,对象为2018年1月至2019年12月上海交通大学附属儿童医院儿童重症监护病房(PICU)收治的1~14岁符合纳入标准的153例急性呼吸衰竭患儿。HFNC成功定义为治疗过程中未升级为有创机械通气并成功撤离HFNC,HFNC失败定义为需要升级为有创机械通气。HFNC设置流量2 L/(kg·min)(最大≤60 L/min),吸入氧浓度(FiO2)0.30~1.00,维持经皮氧饱和度(SpO2)0.94~0.97。观察成功组和失败组在应用HFNC前及应用后1、6、12、24、48 h及超过48 h撤机时动脉血氧分压(PaO2)、动脉血二氧化碳分压(PaCO2),SpO2、PaO2/FiO2等指标的差异。组间比较采用t检验、Mann-Whitney U检验或χ²检验。应用受试者工作特征(ROC)曲线评估呼吸相关临床参数预测HFNC治疗成功的灵敏度和特异度。结果153例患儿中男70例、女83例,HFNC成功组131例(85.6%),失败组22例(14.4%)。成功组HFNC时间为57(38,95)h,起始治疗和全部撤机时PaO2/FiO2分别为187(170,212)mmHg(1 mmHg=0.133 kPa)和280(262,292)mmHg。失败组HFNC时间为19(9,49)h,起始与全部撤机时PaO2/FiO2分别为176(171,189)mmHg和159(156,161)mmHg。初始使用HFNC成功组与失败组PaO2/FiO2比较,HFNC后1 h[196(182,211)比174(160,178)mmHg,Z=-5.105,P<0.01]、6 h[213(203,220)比168(157,170)mmHg,Z=-6.772,P<0.01]、12 h[226(180,261)比165(161,170)mmHg,Z=-4.308,P<0.01]、24 h[229(195,259)比165(161,170)mmHg,Z=-4.609,P<0.01]、48 h[249(216,273)比163(158,169)mmHg,Z=-4.628,P<0.01]及超过48 h撤机时[277(268,283)比157(154,158)mmHg,Z=-3.512,P<0.01]差异均有统计学意义。初始使用HFNC成功组和失败组PaO2在应用后1 h[73.7(71.0,76.7)比70.0(66.2,71.2)mmHg,Z=-4.587,P<0.01]、6 h[79.0(75.0,82.0)比71.0(62.0,72.0)mmHg,Z=-5.954,P<0.01]差异有统计学意义;成功组和失败组SpO2在应用后1 h[0.96(0.95,0.96)比0.94(0.92,0.94),Z=-4.812,P<0.01]、6 h[0.96(0.95,0.97)比0.94(0.91,0.95),Z=-5.024,P<0.01]差异
Objective To investigate the efficacy of high flow nasal cannula(HFNC)in children with acute respiratory failure.Methods A prospective study was conducted.A total of 153 patients aged from 1 to 14 years with acute respiratory failure were enrolled,who were admitted to pediatric intensive care unit(PICU)of Shanghai Children′s Hospital from January 2018 to December 2019.HFNC success was defined as no need for invasive mechanical ventilation and successfully withdrawn from HFNC,while HFNC failure was defined as need for invasive mechanical ventilation.HFNC at a flow rate of 2 L/(kg·min)(maximum≤60 L/min)with inhaled oxygen concentration(FiO2)between 0.30 and 1.00 was applied to maintain percutaneous oxygen saturation(SpO2)of 0.94-0.97.Parameters including arterial partial pressure of oxygen(PaO2),partial pressure of carbon dioxide in artery(PaCO2),SpO2 and PaO2/FiO2 were collected before and during the application of HFNC at 1 h,6 h,12 h,24 h and 48 h,as well as over 48 h after HFNC withdrawn.Comparison between the groups was performed by student t test,Mann-Whitney U test or chi-square test.The sensitivity and specificity of the above parameters in predicting HFNC success were evaluated by receiver operating characteristic(ROC)curve.Results A total of 153 children(70 males and 83 females)were enrolled.Among them,131(85.6%)cases were successfully weaned off from HFNC and 22(14.4%)failed.The duration of HFNC was 57(38,95)hours in the successful group,and the PaO2/FiO2 before HFNC application and after HFNC was withdrawn were 187(170,212)mmHg(1 mmHg=0.133 kPa)and 280(262,292)mmHg,respectively.The duration of HFNC in the failure group was 19(9,49)hours,and the PaO2/FiO2 before HFNC application and after HFNC withdrawn were 176(171,189)mmHg and 159(156,161)mmHg,respectively.The values of PaO2/FiO2 were significantly higher in the successful group than those in the failed group at using HFNC initially 1 h(196(182,211)vs.174(160,178)mmHg,Z=-5.105,P<0.01),6 h(213(203,220)vs.168(157,170)mmHg,Z=-6.772,P<0.01),12 h(226(1
作者
陆叶
崔云
史婧奕
周益平
王春霞
张育才
Lu Ye;Cui Yun;Shi Jingyi;Zhou Yiping;Wang Chunxia;Zhang Yucai(Department of Critical Care Medicine,Shanghai Children′s Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2021年第1期20-26,共7页
Chinese Journal of Pediatrics
基金
上海市科学技术委员会“科技创新行动计划”项目(18411951000)。
关键词
呼吸功能不全
儿童
前瞻性研究
Respiratory insufficiency
Child
Prospective studies
