鼻塞式持续气道正压通气治疗小儿重症肺炎的临床疗效及安全性分析

Clinical Effect and Safety of Nasal Continuous Positive Airway Pressure Ventilation on Severe Pneumonia in Children

目的分析鼻塞式持续气道正压通气治疗小儿重症肺炎的临床疗效及安全性。方法选取2013—2014年在百色市人民医院住院的重症肺炎患儿90例,采用掷硬币法将患儿分为对照组40例和观察组50例。在综合性基础治疗基础上,对照组患儿辅以面罩式给氧治疗,观察组患儿辅以鼻塞式持续气道正压通气治疗。比较两组患儿临床疗效、治疗前和治疗24 h后血气分析指标〔包括动脉血氧分压(PaO2)、血氧饱和度(SaO2)及动脉血二氧化碳分压(PaCO2)〕、临床症状及体征消失时间、住院时间,并对两种治疗方式的安全性进行分析。结果观察组患儿临床疗效优于对照组(P<0.05)。治疗前两组患儿PaO2、Sa O2及PaCO2比较,差异无统计学意义(P>0.05);治疗24 h后观察组患儿PaO2和SaO2高于对照组,PaCO2低于对照组(P<0.05)。观察组患儿气促、呼吸困难、发绀、心率异常、胸骨凹陷、肺部啰音消失时间及住院时间均短于对照组(P<0.05)。观察组除9例患儿出现轻微充血或偶尔轻微瘙痒外,未出现其他明显不适;对照组中24例患儿面罩脱落,3例患儿造成鼻周脸部受到轻微擦伤,所有患儿因进食等原因被迫取下面罩而中断氧疗,从而影响氧疗效果。结论鼻塞式持续气道正压通气治疗小儿重症肺炎的临床疗效确切,能有效改善患儿血气分析指标和临床症状及体征,缩短住院时间,且安全性较高。

Objective To analyze the clinical effect and safety of nasal continuous positive airway pressure ventilation on severe pneumonia in children. Methods A total of 90 children with severe pneumonia were selected in the People＇s Hospital of Baise from 2013 to 2014, and they were divided into control group （n = 40） and observation group （n = 50） according to coin toss method. Based on basic treatment, children of control group were given mask oxygen inhalation, while children of observation group were given nasal continuous positive airway pressure ventilation. Clinical effect, blood- gas analysis index （ including PaO2, Sa02 and PaCO2 ） before treatment and after 24 hours of treatment, disappeared time of clinical symptoms and signs and hospital stays were compared between the two groups, and the safety of the two methods were analyzed. Results The clinical effect of observation group was statistically significantly better than that 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 24 hours of 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 of control group （ P 〈 0. 05）. Disappeared time of anhelation, dyspnea, cyanopathy, abnormality of heart rate, koilosternia, lung rale and hospital stays of observation group were statistically significantly shorter than those of control group （P 〈 0. 05）. Of observation group, 9 cases occurred mild hypcraemia and pruritus; of control group, 24 cases occurred fall out of masks, 3 cases occurred minor scratches, and all of them had to take off the mask because of taking food, which affect the effect of oxygen inhalation. Conclusion Nasal continuous positive airway pressure ventilation has certain clinical effect in treating severe pneumonia in children, can effectively improve the blood - gas analysis index and clinical symptoms and signs, shorten tile hospital stays, and has high safety.