经鼻持续气道正压通气治疗儿童重症肺炎的临床疗效观察  

Clinical observation of nasal continuous positive airway pressure in treatment of severe pneumonia in 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6期434-437,共4页Chinese Pediatric Emergency Medicine

基　　金：国家“十二五”科技支撑计划（2012BAI04B02）

摘　　要：目的探讨经鼻持续气道正压通气（nasal continuous positive airway pressure，NCPAP）治疗儿童重症肺炎的疗效及安全性。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150例重症肺炎患儿临床资料，包括开始使用NCPAP时（0 h）、使用1 h后、4 h后3个时间点的基本生命体征、血气分析指标、气促、喘息、呻吟、鼻翼煽动、三凹征等临床资料。比较使用NCPAP前后各时间点的临床资料，评估NCPAP的临床效果。结果呼吸急促（χ^2＝272.218，P＝0.01）、心率增快（χ^2＝31.625，P＝0.01）、喘息（χ^2＝7.624，P＝0.02）、呻吟（χ^2＝7.203，P＝0.025）、鼻翼煽动（χ^2＝74.032，P〈0.01）、三凹征（χ^2＝117.030，P〈0.01）患儿所占比例在使用NCPAP 1 h、4 h后比之前逐渐下降，差异均具有统计学意义（P均〈0.05）；PaO2/FiO2在使用NCPAP 1 h、4 h后比之前逐渐上升，差异具有统计学意义（F＝7.32，P〈0.01）；有27例患儿NCPAP辅助通气失败，其治疗前PaO2、PaO2/FiO2均低于NCPAP成功的患儿。结论NCPAP对于常规吸氧后仍存在呼吸异常的重症肺炎患儿有明显疗效，且安全可行，值得临床推广。ObjectiveTo evaluate the efficacy and safety of nasal continuous positive airway pressure （NCPAP） in treatment of severe pneumonia in children.MethodsA series of 150 children with severe pneumonia were prospectively included from January 2016 to June 2017.The 150 children all still had shortness of breath after 1 hours of nasal oxygen delivery, and then switched to NCPAP.We collected related clinical parameters （the basic vital signs, blood gas analysis index, shortness of breath, wheezing, groaning, nasal incitement, three depressions sign and NCPAP parameters） at three time points, including 0 h, 1 h, 4 h after using NCPAP.We compared the clinical parameters among the three time points before and after NCPAP with the purpose to assess the efficacy and safety of NCPAP.ResultsThe proportion of shortness of breath（χ^2=272.218, P=0.01）, fast heart rate（χ^2=31.625, P=0.01）, wheezing（χ^2=7.624, P=0.02）, moaning（χ^2=7.203, P=0.025）, nasal flaring（χ^2=74.032, P〈0.01）, three depressions sign（χ^2=117.030, P〈0.01） gradually decreased with statistically different among 0 h, 1 h and 4 h after using NCPAP.PaO2/FiO2（F=7.32, P〈0.01） gradually increased with statistically different among 0 h, 1 h and 4 h after using NCPAP.Twenty-seven patients required intubations.PaO2 and PaO2/FiO2 in patiens received intubations were lower than those in patients only received NCPAP before treatment.ConclusionNCPAP is an effective and safe way for severe pneumonia children who remained abnormal breathing after conventional oxygen inhalation.

关 键 词：经鼻持续气道正压通气 重症肺炎 儿童 

分 类 号：R725.6[医药卫生—儿科]