标题:鼻持续气道正压通气在儿童重症肺炎合并呼吸衰竭治疗中的应用
作者:牛世娥 1,李芳 2,何娟锋 1 1.志丹县人民医院儿科二病区,陕西 延安 717500;2.安塞区人民医院儿科一病区,陕西 延安 717400
卷次:
2020年31卷12期
【摘要】 目的 探讨鼻持续气道正压通气(NCPAP)在儿童重症肺炎合并呼吸衰竭治疗中的应用效果。方法 回顾性分析志丹县人民医院儿科 2017年 1月至 2019年 8月期间收治的 72例重症肺炎合并呼吸衰竭患儿的临床资料,根据是否接受NCPAP治疗将患儿分为观察组(n=40,接受NCPAP治疗)和对照组(n=32,未接受NCPAP治疗),比较两组患儿治疗前及治疗后 12 h的动脉血血气分析指标,包括血氧分压(PaO2)、二氧化碳分压(PaCO2)、血氧饱和度(SaO2);同时记录患儿的临床症状(心率、呼吸困难、肺部啰音、发绀)恢复正常或消失时间,气管插管机械通气及死亡情况。结果 两组患儿治疗后 12 h动脉血PO2、PCO2、SaO2均较治疗前明显改善,其中观察组患儿治疗后上述指标分别为(73.42±10.38) mmHg、(47.27±5.04) mmHg、(92.49±7.38)%,明显优于对照组的(61.98±8.41) mmHg、(54.23±6.32) mmHg、(85.52±8.30)%,差异均有统计学意义(P<0.05);观察组患儿心率恢复正常时间、呼吸困难缓解时间、肺部啰音消失时间和发绀消失时间分别为(32.49±8.20) h、(25.42±4.08) h、(4.27±1.09) h、(26.43±8.20) h,明显快于对照组的(46.53±10.27) h、(38.18±7.76) h、(38.18±7.76) h、(35.08±9.33) h,差异均有统计学意义( P<0.05);两组患儿死亡率比较差异无统计学意义(P>0.05);观察组患儿气管插管率为5.00%,明显低于对照组的18.75%,差异有统计学意义(P<0.05)。结论 鼻持续气道正压通气治疗儿童重症肺炎并发呼吸衰竭可以有效改善患儿的低氧情况,缩短病程,降低气管插管机械通气的比例,临床治疗效果确切。
【关键词】 儿童;重症肺炎;呼吸衰竭;机械通气;鼻持续气道正压通气;动脉血血气分析指标;疗效
【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350(2020)12—1521—03
Application of nasal continuous positive airway pressure in the treatment of severe pneumonia with respiratoryfailure in children.
NIU Shi-e 1, LI Fang 2, HE Juan-feng 1. 1.Ward Two, Department of Pediatrics, Zhidan CountyPeople's Hospital, Yan'an 717500, Shaanxi, CHINA; 2.Ward One, Department of Pediatrics, Ansai District People's Hospital,Yan'an 717400, Shaanxi, CHINA
【Abstract】 Objective To explore the application value of nasal continuous positive airway pressure (NCPAP)in the treatment of severe pneumonia with respiratory failure in children. Methods Seventy-two children with severepneumonia and respiratory failure treated in Department of Pediatrics, Zhidan County People's Hospital were selected asthe study objects. According to whether they received NCPAP treatment, the children were divided into observationgroup (n=40, received NCPAP treatment) and control group (n=32, did not receive NCPAP treatment). Before and 12hours after treatment, the arterial blood gas of the two groups was analyzed, including oxygen partial pressure of arteri-al blood (PaO2), partial pressure of arterial blood carbon dioxide (PaCO2), blood oxygen saturation (SaO2). The time of re-covery or disappearance time of the clinical symptoms (heart rate, dyspnea, rales of lung, cyanosis) were recorded, andmechanical ventilation and death of tracheal intubation were also recorded. Results The PO2, PCO2, and SaO2 in the ar-terial blood of the two groups were significantly improved 12 hours after treatment, and the difference was statisticallysignificant (P<0.05). The above indexes in the observation group were (73.42 ± 10.38) mmHg, (47.27 ± 5.04) mmHg,(92.49±7.38)%, which were significantly better than (61.98±8.41) mmHg, (54.23±6.32) mmHg, (85.52±8.30)% in thecontrol group (P<0.05). The time of heart rate recovery, dyspnea relief, rales disappearance and cyanosis disappearancein the observation group were (32.49±8.20) h, (25.42±4.08) h, (4.27±1.09) h, (26.43±8.20) h, respectively, which weresignificantly shorter than (46.53±10.27) h, (38.18±7.76) h, (38.18±7.76) h, (35.08±9.33) h in the control group (P<0.05).There was no significant difference in mortality between the two groups (P>0.05). The proportion of intubation in the ob-servation group was 5.00%, significantly lower than 18.75% in the control group (P<0.05). Conclusion Nasal continu-ous positive airway pressure has definite clinical effect in the treatment of severe pneumonia complicated with respirato-ry failure in children. It can effectively improve the hypoxic condition of children, shorten the course of disease, and re-duce the proportion of mechanical ventilation through tracheal intubation.
【Key words】 Children; Severe pneumonia; Respiratory failure; Mechanical ventilation; Nasal continuous posi-tive airway pressure ventilation; Arterial blood gas analysis index; Efficacy
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