经鼻持续呼吸道正压对肺炎并心力衰竭患儿心功能的影响

Effect of Nasal Continuous Positive Airway Pressure on Cardiac Function in Children with Pneumonia Complicated with Heart Failure

目的研究经鼻持续呼吸道正压(NCPAP)对肺炎并心力衰竭患儿心功能的影响。方法选择2008年10月-2009年3月在北京儿童医院急救室诊断为肺炎并心力衰竭的患儿22例,年龄1个月15天～1岁8个月,符合NCPAP应用指征,进行前瞻性自身对照临床研究。采用便携式超声心功能监护仪(USCOM)分别测定NCPAP治疗前及NCPAP0.04～0.05kPa治疗后的心功能相关指标。结果应用NCPAP治疗30min后,患儿心率由(173±10)次/min降至(151±13)次/min(P<0.05);呼吸频率由(69±10)次/min降至(49±12)次/min(P<0.05);左心室每搏输出量指数由(31.818±4.521)mL/m2升至(35.909±7.177)mL/m2(P<0.05);心指数无明显变化[(5.486±0.976)L/(min.m2)vs(5.386±1.134)L/(min.m2)](P>0.05)。结论NCPAP可提高肺炎并心力衰竭患儿左心室每搏输出量指数,降低心率和呼吸频率,但对心指数无明显影响。NCPAP可改善肺炎并心力衰竭患儿的心功能。

Objective To investigate the effect of nasal continuous positive airway pressure （NCPAP） on cardiac function in children with pneumonia complicated with heart failure. Methods Twenty - two children with pneumonia complicated with heart failure were selected in emergency room of Beijing Children＇s Hospital Affiliated to Capital Medical University from Oct. 2008 to Mar. 2009 ,aged 1 month and 15 days to 2 years and 8 months,prospective clinical study. Cardiac function[ including cardiac index（CI） ,heart rate（HR） and stroke volume index（SVI） ] before and after NCPAP 0.04 -0.05 kPa for 30 minutes were monitored by ultrasonic cardiac output monitoring（USCOM）. Resuits After the application of 0.04 - 0.05 kPa NCPAP for 30 minutes, the heart rate decreased signi-ficantly [ （ 173 ± 10 ） beats/min vs （ 151 ±13 ） beats/min P 〈 0. 05 ] ; the respiratory rate decreased significantly [ （ 69 ±10 ） beats/min vs （ 491 ±12 ） beats/min P 〈0. 05 ]. The stroke volume index elevated significantly [ （31. 815 ±4.521 ） mL/m^2 vs （ 35. 909 ± 7. 177 ） mL/m^2 P 〈 0. 05 ]. However, there was no significant difference in cardiac index [ （5.486 ±0.976） L/（min/m^2） vs （5.386 ± 1. 134） L/（min/m^2） P 〉0.05]. Conclusions NCPAP might improve cardiac function by increasing stroke volume index and decreasing heart rate and respiratory rate in children with pneumonia complicated with heart failure