危重症患儿使用经鼻持续气道正压通气的时机探讨及评估  

Evaluation of the timing of application of nasal continuous positive airway pressure in critically ill children

作　　者：臧平[1] 卢秀兰[1] 唐亮 祝益民[2] 黄娇甜[1] 肖政辉[1] 张新萍[1] Zang Ping;Lu Xiulan;Tang Liang;Zhu Yimin;Huang Jiaotian;Xiao Zhenghui;Zhang Xinping(Emergency Center,Hunan Provincial Children's Hospital,Changsha 410007,China)

机构地区：[1]湖南省儿童医院急救中心,长沙410007 [2]湖南省人民医院儿童医学中心,长沙410005 [3]南华大学儿科学院,长沙421000

出　　处：《中国小儿急救医学》2018年第11期808-812,共5页Chinese Pediatric Emergency Medicine

基　　金：国家“十二五”科技支撑计划(2012BA104802);湖南省卫生计生委科研计划课题项目(C2016022);儿童急救医学湖南省重点实验室(2018TP1028).

摘　　要：目的 研究 PICU 使用经鼻持续气道正压通气( nasal continuous positive airway pressure,NCPAP)患儿的临床资料,探讨NCPAP在危重症患儿中的使用时机及范围.方法 采用前瞻性研究收集2016 年1 月至2017 年6 月入住我院 PICU,在鼻导管给氧1 h 后仍存在呼吸急促改用NCPAP 的192例重症患儿的临床资料.根据使用NCPAP 的氧分压不同,将患儿分为A组[呼吸急促(PaO2≥70 mmHg,1 mmHg =0. 133 kPa)], B 组[呼吸急促合并氧分压减低( 50 mmHg < PaO2<70 mmHg)],C组[呼吸急促合并呼吸衰竭(PaO2≤50 mmHg)],比较3组患儿不同时间点各项指标的变化,明确 NCPAP 的临床效果.结果 192 例患儿原发疾病以呼吸系统疾病为主,共 161 例(83. 85%);重症手足口病14 例(7. 29%),严重脓毒症10 例(5. 21%),其他多脏器异常混合性疾病7例(3. 65%). PaO2/FiO2在使用NCPAP 1 h、4 h后逐渐上升,A组氧合改善情况最明显,3组间比较差异有统计学意义(P<0. 05);3组患儿心率增快、呼吸急促在使用NCPAP 1 h、4 h后差异均有统计学意义(P<0. 05);A组患儿通气失败2例(失败率3. 57%);B组患儿通气失败9例(失败率11. 11%);C组患儿通气失败30 例(失败率54. 55%),3 组患儿无创辅助通气失败率比较差异有统计学意义( χ2=51. 684,P<0. 001);3组患儿出院情况比较差异有统计学意义(P<0. 05).结论 NCPAP对于常规吸氧仍存在呼吸异常的危重症患儿有明显疗效;鼻导管给氧下仍存在呼吸衰竭的患儿,在使用NCPAP 时易导致无创辅助通气失败,使用过程中需要密切动态监测病情.Objective To study the clinical data of patients treated with nasal continuous positive airway pressure (NCPAP)in PICU,and to explore the application time and range of NCPAP in critically ill children.Methods A prospective study was conducted to collect clinical data of 192 severe patients admitted to PICU from January 2016 to June 2017 who had shortness of breath after giving oxygen through nasal catheter for 1 hour and then switched to NCPAP.According to using NCPAP oxygen partial pressure,children were divided into three groups:group A[shortness of breath (PaO2≥70mmHg,1mmHg =0.133kPa)], group B [shortness of breath combined,reduced oxygen partial pressure(50mmHg <PaO2<70mmHg)],and group C [shortness of breath combined respiratory failure (PaO2≤50mmHg)3.The indicators of three groups of children at different time points of NCPAP were compared.Results Among 192 children,161(83.85%) had respiratory diseases,14(7.29%) had severe hand-foot-mouth disease,10(5.21%) had severe sepsis, and 7(3.65%) had other multiple organ disorders.PaO2/FiO2 gradually increased after using NCPAP for 1 hour and 4 hours,and the improvement of oxygenation in group A was most obvious,there was significant difference among the three groups (P <0.05).There were significant differences in heart rate,shortness of breath after using NCPAP for 1 hour and 4 hours among the three groups (P <0.05).There were 2 cases of ventilation failure in group A (failure rate 3.57%),9 cases (11.11%) of ventilation failure in group C,30 cases (54.55%) of ventilation failure in group C,and there was significant difference in the failure rate of noninvasive ventilation among the three groups (x^2=51.684,P <0.001).There were significant differences in the discharge rate among the three groups (P <0.05).Conclusion NCPAP has obvious effect on the critical- ly ill children with conventional oxygen remaining respiratory abnormalities;Children with respiratory failure under nasal catheter are prone to suffer from the failure of noninvasive assisted ventilation when

关 键 词：危重症 儿童 经鼻持续气道正压通气 应用时机 

分 类 号：R720.597[医药卫生—急诊医学]