鼻塞式持续性气道正压通气治疗小儿重症肺炎的临床效果

摘要

目的：探讨鼻塞式持续性气道正压通气（CPAP）治疗小儿重症肺炎的临床效果。方法选取2013年1月—2015年1月咸阳彩虹医院收治的重症肺炎患儿134例，按照随机数字表法分为对照组与观察组，各67例。对照组患儿予以经鼻导管高流量吸氧治疗，观察组患儿予以鼻塞式 CPAP 治疗，两组患儿均治疗24 h。比较两组患儿临床症状缓解时间（心率恢复正常时间、呼吸困难缓解时间、肺啰音消失时间、发绀消失时间、胸骨凹陷消失时间）、住院时间、治疗前后血气分析指标〔氧分压（PaO2）、血氧饱和度（SaO2）、二氧化碳分压（PaCO2）〕、临床效果及并发症发生情况。结果观察组患儿心率恢复正常时间、呼吸困难缓解时间、肺啰音消失时间、发绀消失时间、胸骨凹陷消失时间以及住院时间短于对照组（P ﹤0.05）。治疗前两组患儿 PaO2、SaO2、PaCO2比较，差异无统计学意义（P ﹥0.05）；治疗后观察组患儿 PaO2、SaO2高于对照组，PaCO2低于对照组（P ﹤0.05）；两组患儿治疗后 PaO2、SaO2高于治疗前，PaCO2低于治疗前（P ﹤0.05）。观察组患儿临床效果优于对照组（ P ﹤0.05）。两组患儿均未发生严重并发症。结论鼻塞式 CPAP 治疗小儿重症肺炎的临床效果确切，可有效改善患儿临床症状及血气分析指标，缩短患儿住院时间，且安全性较高。%Objective To explore the clinical effect of nasal continuous positive airway pressure ventilation in treating children with severe pneumonia. Methods A total of 134 children with severe pneumonia were selected in the Rainbow Hospital of Xianyang from January 2013 to January 2015,and they were divided into control group and observation group according to random number table,each of 67 cases. Children of control group received high - flow oxygen inhalation under nasal catheter, while children of observation group received nasal continuous positive airway pressure ventilation;both groups treated for 24 hours. Remission time of clinical symptoms( including recovery time of heart rate,remission time of dyspnea,disappearance time of lung rale,cyanosis and koilosternia),hospital stays,blood - gas analysis index(including PaO2 ,SaO2 and PaCO2 ) before and after treatment,clinical effect and incidence of complications were compared between the two groups. Results Recovery time of heart rate,remission time of dyspnea,disappearance time of lung rale,cyanosis and koilosternia,and hospital stays of observation group were statistically significantly shorter than those of control group ( P ﹤ 0. 05 ). No statistically significant differences of PaO2 ,SaO2 or PaCO2 was found between the two groups before treatment(P ﹥ 0. 05);after treatment, PaO2 and SaO2 of observation group were statistically significantly higher than those of control group,while PaCO2 of observation group was statistically significantly lower than that control group(P ﹤ 0. 05). After treatment,PaO2 and SaO2 of the two groups were statistically significantly higher than those before treatment,while PaCO2 of the two groups was statistically significantly lower than that before treatment,respectively(P ﹤ 0. 05). The clinical effect of observation group was statistically significantly better than that of control group(P ﹤ 0. 05). No one of the two groups occurred any severe complications. Conclusion Nasal continuous positive airway pressure ventilation has certain clinical effect in treating children with severe pneumonia,can effectively relive the clinical symptoms,adjust the blood - gas analysis index,shorten the hospital stays,and is relatively safe.