无创持续气道正压通气辅助治疗小儿Ⅲ度喉梗阻疗效观察

Efficacy of noninvasive continuous positive airway pressure on infants with degree Ⅲ laryngeal obstruction

目的 探讨无创持续气道正压通气（noninvasive continuous positive airway pressure,nCPAP）辅助治疗Ⅲ度喉梗阻的疗效.方法 将我院儿童重症监护病房2007年1月至2012年12月收治的62例急性感染性喉炎合并Ⅲ度喉梗阻患儿分为观察组32例和对照组30例.观察组患儿给予nCPAP治疗.对照组给予常规口鼻罩氧疗.两组均应用小剂量甲泼尼龙静脉注射联合氧气驱动雾化吸人肾上腺素等治疗.结果 观察组患儿入院治疗后1h内有效率100％ （32/32）,平均起效时间（43.65±10.34）min;对照组患儿1h内起效13例,有效率仅为43.3％ （13/30）;2h内起效22例,有效率73.3％（22/30）;平均起效时间为（73.70±15.86）rn in.两组起效时间及疗效比较差异均有统计学意义（P＜0.01）.入院治疗2h后,观察组所有患儿缺氧症状均得到明显改善,监测心率[（146.39±10.61）次/min]、血氧饱和度（98.53％±0.42％）、动脉血氧分压[（93.64 ±5.68） mm Hg]及二氧化碳分压[（44.25±5.76） mm Hg]均较入院时[（172.24±7.80）次/min、90.16％±2.58％、（65.33±6.27） mm Hg、（48.60±4.39） mmHg]明显改善,差异均有统计学意义（P＜0.01）.结论 nCPAP辅助治疗小儿Ⅲ度喉梗阻疗效满意,优于常规氧疗.

Objective To explore the efficacy of noninvasive continuous positive airway pressure （nCPAP） on infants with degree Ⅲ laryngeal obstruction.Methods Sixty-two infants of acute laryngitis with degree Ⅲ laryngeal obstruction were divided into observation group （n =32） and control group （n =30）,which were admitted to our PICU from Jan 2007 to Dec 2012.Thirty-two cases in the observation group were treated using the nCPAP.Thirty infants in the control group received regular mouth-nose mask oxygen therapy.The infants in both groups were given small-dose intravenous injection of methylprednisolone and inhalation of oxygen-driven nebulized epinephrine.Results In a hour after treatments,the effective rate in observation group was 100％,and the average duration for the treatments to take effect was （43.65 ±10.34） min.In control group,symptoms of 13 infants were improved within one hour （the effective rate was 43.3 ％）,and symptoms of 22 infants were improved within two hours （the effective rate was 73.3 ％）.The average duration for the treatments to take effect in control group was （73.70 ± 15.86） min.The differences of effective rates and take-effect duration between the two groups were statistically significant （P ＜ 0.01）.After two hours＇ treatments,hypoxic symptoms of all infants in the observation group were obviously improved.The average heart rate[（172.24 ± 7.80） times per minute],the average oxygen saturation （90.16％ ±2.58％）,the average arterial partial pressure of oxygen [（65.33 ±6.27） mm Hg],and the average partial pressure of carbon dioxide [（48.60 ± 4.39） mm Hg] were improved significantly compared with those before treatment [（146.39 ± 10.61） times per minute,98.53 ％ ± 0.42 ％,（93.64 ± 5.68） mm Hg,（44.25 ±5.76） mm Hg）].The differences were statistically significant （P ＜ 0.01）.Conclusion The nCPAP auxiliary treatment is effective for infants with degree Ⅲ laryngeal obstruction,more effective than the regular oxygen therapy.