标题：无创正压通气治疗儿童轻度急性呼吸窘迫综合征疗效观察

      作者：李芳 1，王波 2    榆阳区人民医院儿童重症医学科 1、儿内一科 2，陕西 榆林 719000

      卷次： 2022年33卷6期

      【摘要】 目的 比较两种无创正压通气治疗轻度急性呼吸窘迫综合征(ARDS)患儿的疗效并分析其影响因素。方法 选择榆阳区人民医院儿童重症医学科2019年1月至2020年12月间收治的112例轻度ARDS患儿为研究对象，采用随机数表法分为对照组和研究组，每组56例，对照组患儿采用经鼻持续气道正压通气治疗，研究组患儿采取无创双水平气道正压通气治疗。比较两组患儿治疗前后的二氧化碳分压(PCO2)、动脉血氧分压(PaO2)、氧合指数(PaO2/FiO2)、肺动脉压力(PAP)等血气指标变化，以及通气时间、呼吸暂停症状消失时间、住院时间、通气失败率和呼吸暂停发作率，采用Logistic回归分析法分析影响通气失败的因素。结果 治疗前，两组患儿的PaCO2、PaO2、PaO2/FiO2、PAP比较差异均无统计学意义(P>0.05)；治疗后，研究组患儿的PaCO2和PAP分别为(44.24±4.26) mmHg、(37.54±4.98) mmHg，明显低于对照组的(47.46±4.87) mmHg、(41.22±4.64) mmHg，PaO2和PaO2/FiO2分别为(80.01±5.17) mmHg、(311.42±22.57) mmHg，明显高于对照组的(76.41±5.24) mmHg、(258.64±20.13) mmHg，差异均有统计学意义(P<0.05)；治疗后，研究组患儿的呼吸暂停症状消失时间为(46.33±4.35) h，早于对照组的(50.74±5.18) h，呼吸暂停再发率为16.07%，明显低于对照组的32.14%，差异均有统计学意义(P<0.05)；两组患儿的通气时间和通气失败率比较差异均无统计学意义(P>0.05)；采用Logistic回归分析结果显示，胎龄、体质量及分娩前激素使用情况为影响通气失败的危险因素(P<0.05)。结论 无创正压通气是治疗轻度ARDS患儿的有效手段，相较于经鼻持续气道正压通气，双水平气道正压通气对ARDS患儿的疗效更优，临床治疗时应充分考虑相关影响因素并结合医院实际情况，给予ARDS患儿最优的治疗方案。
      【关键词】 无创正压通气；新生儿；轻度；急性呼吸窘迫综合征；疗效；危险因素
      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2022）06—0758—04

Effect of noninvasive positive pressure ventilation in the treatment of children with mild acute respiratorydistress syndrome.
LI Fang 1, WANG Bo 2. Department of Pediatric Critical Care Medicine 1, Department of Pediatrics 2,People's Hospital of Yuyang District, Yulin 719000, Shaanxi, CHINA
【Abstract】 Objective To compare the efficacy of two kinds of noninvasive positive pressure ventilation in thetreatment of children with mild acute respiratory distress syndrome (ARDS). Methods A total of 112 children withmild ARDS treated in the Department of Pediatric Critical Medicine, Yuyang District People's Hospital from January2019 to December 2020 were selected as the research objects. They were randomly divided into a control group and astudy group, with 56 children in each group. The control group was treated with nasal continuous positive airway pres-sure ventilation, and the study group was treated with noninvasive Bi level positive airway pressure ventilation. Thechanges of blood gas indexes such as partial pressure of carbon dioxide (PCO2), partial pressure of arterial oxygen(PaO2), oxygenation index (PaO2/FiO2), pulmonary artery pressure (PAP), ventilation time, disappearance time of apneasymptoms, hospitalization time, ventilation failure rate, and apnea attack rate were compared between the two groups be-fore and after treatment, and the influencing factors of ventilation failure were analyzed. Results Before treatment,there was no significant difference in PaCO2, PaO2, PaO2/FiO2, PAP between the two groups (P>0.05); After treatment,PaCO2 and PAP in the study group were (44.24±4.26) mmHg, (37.54±4.98) mmHg, significantly lower than (47.46±4.87) mmHg, (41.22±4.64) mmHg in the control group, while PaO2, PaO2/FiO2 in the study group were (80.01±5.17) mmHg,(311.42±22.57) mmHg, significantly higher than (76.41±5.24) mmHg, (258.64±20.13) mmHg in the control group (P<0.05). The disappearance time of apnea symptoms in the study group was (46.33±4.35) h, which was earlier than (50.74±5.18) h in the control group, and the recurrence rate of apnea was 16.07%, significantly lower than 32.14% in the controlgroup, with statistically significant difference (P<0.05). There was no significant difference in ventilation time and fail-ure rate between the two groups (P>0.05). Logistic regression analysis showed that gestational age, body weight, andhormone use before delivery were the risk factors of ventilation failure. Conclusion Noninvasive positive airway pres-sure ventilation is an effective method in the treatment of children with mild ARDS. Compared with nasal continuouspositive airway pressure ventilation, bi level positive airway pressure ventilation is more effective in the treatment ofchildren with ARDS. Clinical treatment plan for children with ARDS should be formulated by fully considering the rele-vant factors and combining with the actual situation of the hospital.
      【Key words】 Noninvasive positive pressure ventilation; Newborn; Light; A