无创正压通气在重症支气管哮喘治疗中的应用

Application of Noninvasive Positive Pressure Ventilation in Treatment for Severe Bronchial Asthma in Children

目的观察在常规治疗的基础上加用无创正压通气(NIPPV)对儿童重症支气管哮喘(哮喘)的治疗作用。方法选取急性发作期重症哮喘患儿40例。随机分为NIPPV组20例和对照组20例。NIPPV组在解痉平喘、抗感染、祛痰、纠正酸碱和水电解质平衡等综合治疗基础上,于发病24 h内予NIPPV治疗;对照组除上述基础治疗外予鼻导管吸氧。监测2组治疗前及治疗4 h、8 h、12 h及24 h心率、动脉血pH、动脉血氧分压[pa(O2)]、动脉血二氧化碳分压[pa(CO2)]、血氧饱和度(SpO2)水平。结果治疗后对照组和NIPPV组心率、动脉血pH值、pa(O2)、pa(CO2)及SpO2水平均较治疗前明显改善,并且随治疗时间的延长而改善有所增加,差异均有统计学意义(Pa<0.01)。治疗后,NIPPV组较对照组改善更明显,NIPPV组在治疗4 h、8 h的心率[(119±10)次.min-1、(97±12)次.min-1]、动脉血pH(7.28±0.06、7.34±0.04)、pa(O2)[(67±6)mmHg、(81±5)mmHg](1 mmHg=0.133 kPa)、pa(CO2)[(40±9)mmHg、(31±9)mmHg]、SpO2[(96.23±1.83)%、(98.04±1.32)%]较对照组心率[(125±11)次.min-1、(104±10)次.min-1]、动脉血pH(7.22±0.08、7.29±0.07)、pa(O2)[62±6)mmHg、(76±4)mmHg]、pa(CO2)[(46±9)mmHg、(37±7)mmHg]及SpO2[(95.05±1.69)%、(97.01±1.41)%]均明显改善,差异均有统计学意义(Pa<0.05)。48 h后NIPPV组患儿全部脱机成功,且无严重并发症发生。结论早期应用NIPPV配合常规药物治疗有助于减缓重症哮喘的病情恶化,可提高急性发作的治疗效果,是抢救重症哮喘的一种安全有效的方法。

Objective To observe the therapeutic effect of non invasive positive pressure ventilation（NIPPV） for severe bronchial asthma in children on the basis of conventional therapy. Methods Forty children with severe bronchial asthma were randomly divided into 2 groups：20 cases in control group with only oxygen inhalation through nasal catheter and common therapy such as relieving spasm and cough,eliminating phlegm,anti-inflammation and adjusting acid-base and electrolyte balance;20 cases in NIPPV therapy group with NIPPV the-rapy besides common therapy within 24 hours.Heart rate,blood pH,partial pressure of oxygen in artery[pa（O2）],partial pressure of carbon dioxide in artery[pa（CO2）] and pulse oxygen saturation（SpO2） were monitored in the 2 groups before treatment and 4 h,8 h,12 h,24 h after treatment. Results Heart rate,blood pH,pa（O2）,pa（CO2） and SpO2 of patients in both control group and NIPPV therapy group were improved comparing to pretherapy,and the improvements were significant with treating time increasing.The improvements in NIPPV therapy group were more significant than those in control group.In therapy group after 4 h and 8 h,heart rate[（119±10）beats·min-1,（97±12） beats·min-1）],blood pH（7.28±0.06,7.34±0.04）,pa（O2）[（67±6） mmHg,（81±5） mmHg]（1 mmHg=0.133 kPa）,pa（CO2）[（40±9） mmHg,（31±9） mmHg] and SpO2[（96.23±1.83）%,（98.04±1.32）%]raised significantly compared with those in control group [heart rate（125±11）beats·min-1,（104±10） beats·min-1],blood pH（7.22±0.08,7.29±0.07）,pa（O2）[（62±6） mmHg,（76±4） mmHg],pa（CO2）[（46±9） mmHg,（37±7） mmHg],SpO2[（95.05±1.69）%,（97.01±1.41）%].After 48 h,all the children in NIPPV therapy group successfully took off respirator without any serious complications. Conclusions Early application of NIPPV with conventional therapy is an effective way to modify symptoms and rescue children with severe asthma.NIPPV is an effective therapeutic method for severe asthma in children.