鼻塞持续气道正压通气治疗重症毛细支气管炎的临床研究

Therapeutic effect of nasal continuous positive airway pressure on severe bronchiolitis

目的 探讨鼻塞持续气道正压通气（NCPAP）治疗婴儿重症毛细支气管炎的疗效。方法 对38例住院确诊重症婴儿毛细支气管炎患儿，在常规药物治疗基础上分为NCPAP治疗组21例，对照组（非NCPAP治疗）17例，分别监测其治疗前、治疗后1h及24h动脉血气，心率及呼吸频率，同时观察临床不良反应及合并症。结果 NCPAP组与对照组治疗24h后比较，PaO2明显升高（P〈0．01），呼吸改善（P〈0．01）、心率及PaCO2明显降低（P〈0．05）；NCPAP治疗1、24h后与应用前比较，PaO2明显升高。心率、呼吸及PaCO2明显降低（P〈0．01）。NCPAP组需加用洋地黄类药物控制心率的人数较对照组明显减少（P〈0．01）；NCPAP组平均住院天数与对照组比较明显降低（P〈0．05），与同期收治63例非重症组毛细支气管炎患儿平均住院天数比较差异无显著性（P〉0．05）。NCPAP组仅1例需改用气管插管辅助机械通气（CMV），无死亡病例，对照组4例需改用CMV，1例拒绝CMV、放弃治疗后死亡。结论 重症婴儿毛细支气管炎患儿应用NCPAP治疗简便、安全、有效且并发症少，同时减少洋地黄、CMV的应用。

Objective To study the therapeutic effect of nasal continuous positive airway pressure（NC- PAP） on severe bronchiolitis. Methods Thirty-eight children with severe bronchiolitis were divided into NCPAP （n = 21） and control group （n = 17）. In addition to the routine bronchiolitis therapy for control group, NCPAP group were given NCPAP therapy. Arterial blood gas, heart rate and breathing frequency were monitored respectively before treatment and 1 hr and 24 hrs after treatment. Clinical observation of adverse effects and complications were performed as well. Results As compared with the control, NCPAP group showed a significant increase in PaO2 （P 〈 0.01）, a decrease in respiration rate, heart rate and PaCO2 after 24 hrs of treatment （P 〈 0.05）. In contrast to those before treatment, NCPAP group also showed a significant increase in PaO2 （P 〈 0.05）, a decrease in respiration rate, heart rate and PaC.O2 at 1 hr. and 24 hrs after treatment （P 〈 0.01 ）. Fewer patients in NCPAP group needed digitalis （P 〈 0.01 ）. Average hospital stay was shorter in NCPAP group than that of the control （ P 〈 0.05 ）, furthermore, average hospital stay was not significantly different between NCPAP group and the mild bronchiolitis children during the same period （ P 〉 0.05）. No death occurred in the NCPAP group, with only one case supported with controlled mechanical ventilation （CMV）. However, 4 children in the control group were treated with CMV and one died after refusing CMV and quitting therapy himself. Conclusion NCPAP therapy for severe bronchiolitis in children is convenient, safe, effective, and small in the number of complications and chance of digitalis usage.