标题：无创正压机械通气治疗小儿急性呼吸衰竭的临床研究

      作者：张笃飞，廖 锋，曾 霞，蔡露良，马志超，孙 嵩
    （海南省人民医院儿科，海南 海口 570311）

      卷次： 2013年24卷15期

      【摘要】 目的 探讨无创正压机械通气(NIPPV)治疗小儿急性呼吸衰竭(ARF)失败的危险因素。方法 2009
年6月至2012年6月海南省人民医院儿科重症病房收治的96例由各种病因导致ARF并且应用NIPPV治疗的患
儿，按照治疗结果分为NIPPV成功组和NIPPV失败组，采用单因素和非条件Logistic回归分析对两组患儿的临床
资料进行分析。结果 NIPPV成功组 61例，NIPPV失败组 35例。治疗成功率为 63.5% (61/96)。成功组NIPPV
治疗1 h后PaCO2与治疗前对比明显降低，差异有统计学意义，失败组NIPPV治疗1 h后PaCO2与治疗前比较差异
无统计学意义，与NIPPV治疗结果有关的6个变量是间质性肺疾病、神经源性肺水肿、上机前PaCO2、呼吸指数、
APACHEⅡ评分和上机1 h后的PaCO2。经去除各因素之间相互混杂的影响，仍然与NIPPV治疗结果有关的变
量是：神经源性肺水肿、呼吸指数、APACHEⅡ评分和上机 1 h后 PaCO2。结论 神经源性肺水肿、呼吸指数、
APACHEII评分及上机1 h后的PaCO2水平是NIPPV治疗失败的危险因素。

      【关键词】 急性呼吸衰竭；无创正压机械通气；小儿

      【中图分类号】 R725.6 【文献标识码】 A 【文章编号】 1003—6350（2013）15—2224—04


Clinical study of noninvasive positive pressure ventilation in the treatment of children with acute respiratory
failure.
ZHANG Du-fei, LIAO Feng, ZENG Xia, CAI Lu-liang, MA Zhi-chao, SUN Song. Department of Paediatrics,
People's Hospital of Hainan Province, Haikou 570100, Hainan, CHINA

【Abstract】 Objective To explore the risk factors associated with development of noninvasive positive pres-
sure ventilation (NIPPV) failure in children with acute respiratory failure (ARF). Methods A total of 96 children
with ARF treated with NIPPV, who were admitted to Pediatric Intensive Care Unit of People's Hospital of Hainan
Province from Jun. 2009 to Jun. 2012, were divided into NIPPV success group and NIPPV failure group. Logistic re-
gression analysis was performed on the clinical data. Results NIPPV success group consisted of 61 cases, and NIP-
PV failure group consisted of 35 cases. There were significant differences between the two groups in interstitial pneu-
monia, neurogenic pulmonary edema, arterial carbon dioxide tension (PaCO2) before NIPPV, respiratory index (RI),
APACHE Ⅱ score and PaCO2 after 1 hour NIPPV. Neurogenic pulmonary edema, RI, APACHE Ⅱ score and PaCO2
after 1 hour NIPPV were risk factors for the development of NIPPV failure in children with ARF by logistic regression
analysis. Conclusion Neurogenic pulmonary edema, respiratory index, APACHE Ⅱ score and PaCO2 after 1 hour
NIPPV are the risk factors for the development of NIPPV failure in children with ARF.

      【Key words】 Acute respiratory failure; Noninvasive positive pressure ventilation; Children
·论 著·