改良高流量鼻插管(HFNC)在新生儿呼吸窘迫综合征(NRSD)早产儿中的应用

Akhyar Nur Uhud, Arie Utariani, Lucky Andriyanto
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摘要

新生儿呼吸窘迫综合征(NRSD)是重症监护(NICU)新生儿最常见的原因之一。近年来,一些NICU中心正在使用高流量鼻插管(HFNC)。在早产儿使用HFNC作为呼吸辅助工具时,HFNC与鼻腔持续气道正压通气(CPAP)(连续或间歇)的有效率相同。病例报告:一名三天大的男婴因II级HMD呼吸衰竭被麻醉,怀疑有先天性心力衰竭。初始条件显示呼吸频率为70-80x /分钟,鼻孔呼吸,肋间和腹部在CPAP面罩的帮助下,导管后SpO2为85% (Pinsp 10, Fio2 70%)。左、右基肺均有Ronchi音,血流动力学脉搏180 ~ 195x / min,无创血压95/34 mmHg(54),未见心脏杂音。在第1天第3天,患者使用CPAP面罩,直到患者呕吐并咨询麻醉师。第3天,患者使用HFNC;第7天至第10天,患者使用新生儿鼻小管供氧。直到第10天,患者仍在NICU接受0.5升/分钟的氧气治疗,SpO2在93-96%之间,病情稳定,但仍需要氧气。结论:改良高流量鼻插管(HFNC)治疗新生儿呼吸窘迫综合征(NRSD)比CPAP更有效。使用HFNC与鼻CPAP相比,鼻外伤和气胸的发生率较低。
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The Use of Modified High Flow Nasal Cannula (HFNC) In Preterm Infants With Neonatal Respiratory Distress Syndrome (NRSD) In Primary ICU Services
Introduction: NRSD (Neonatal Respiratory Distress Syndrome) is one of the most frequent causes of newborns in intensive care (NICU). Several NICU centers are now using the High Flow Nasal Cannula (HFNC) in recent years. With the use of HFNC as a breath aid in preterm infants, HFNC had the same efficacy ratio as nasal Continuous Positive Airway Pressure (CPAP) (continuous or intermittent). Case Report: A three-day-old baby boy was admitted to anesthesia with respiratory failure due to grade II HMD with suspicion of congenital heart failure. The initial condition showed that a respiratory rate of 70-80x / minute, breathing of the nostrils and retractions in the intercostals and abdomen with 85% post ductal SpO2 with the help of a CPAP mask (Pinsp 10, Fio2 70%). There was a Ronchi sound in the right and left basal lungs, and hemodynamics obtained a pulse of 180-195x / minute, non-invasive blood pressure 95/34 mmHg (54), heart murmurs were not found. During day 1 - day three, the patient uses a CPAP mask until the patient vomits and being consulted to an Anesthesiologist. On day 3 - day seven, the patient uses HFNC; after day seven until day 10, the patient uses neonatal nasal canularis oxygen. Until day 10, the patient is still being treated at the NICU by administering oxygen 0.5 liters/minute with SpO2 ranging from 93-96% with stable conditions but still needing oxygen. Conclusion: The use of Modified High Flow Nasal Cannula (HFNC) in preterm infants with Neonatal Respiratory Distress Syndrome (NRSD) is more effective and efficient than CPAP. The use of HFNC was associated with a lower incidence of nasal trauma and pneumothorax than nasal CPAP.
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